CAD/CAM international No. 2, 2022

Cover / Editorial / Content / Preferences for xed restorations and resulting impact on the US and European overdenture markets / Global healthcare systems unprepared for another pandemic, research shows / Artificial intelligence may automate design of biomimetic single-tooth prostheses / Dental Thermal App offers “a simple, yet intuitive, clinically based workflow” - An interview with Dr Les Kalman / Both digital and analogue dental workows need to be your best friend! / Help your patients say yes! / Complete rehabilitation with guided surgery: Focus on temporary restoration / Digital procedures for the design of a sequential occlusion in a complex clinical case / A chairside CAD/CAM lithium disilicate block in the hands of the dental technician: Giving that extra touch / Transforming dentistry with groundbreaking technologies - Lifelike restorations with a micro-layer of porcelain / Prof. Rainer Seemann believes that: “Dentsply Sirona World provides a window into the future of dentistry, which is digital” / How 3D printing increases value for your patients / Trends & applications / Manufacturer news / Features / Meetings / Submission guidelines / Imprint

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issn 1616-7390 • Vol. 13 • Issue 2/2022

international magazine of dental laboratories

case report

A chairside CAD/CAM lithium disilicate block
in the hands of the dental technician

opinion

Both digital and analogue dental workflows
need to be your best friend!

industry report

Transforming dentistry with
groundbreaking technologies

2/22

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The perfect pairing.

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editorial

Magda Wojtkiewicz
Managing Editor

Importance of effective
communication
According to the Oxford English Dictionary, communication is “the transmission or exchange of information,
knowledge, or ideas, by means of speech, writing, mechanical or electronic media from one place, person or
group to another”. This seems simple, but the process
of transmitting of a message can be complex, being
affected by many things. These include emotions, the
cultural situation, the medium used to communicate
and even the location of the sender or receiver of the
message.
Many of us believe that communication is instinctive and
easy. If so, why does our message so often go astray
when we try to communicate with others? Why can we
say one thing and yet the other person hears something
else? Where does this miscommunication come from?
Aside from language issues, miscommunication can
be caused by stress, lack of control of emotions, poor
or misplaced focus in communicating, and inconsistent
or negative body language, among many other factors.
Ability to combat your emotions quickly and return to a
calm state significantly improves communication skills.
Only when we are calm can we remain focused and
be able to judge what sort of response the situation
requires, including whether it is better to remain silent.
Besides affecting the process of transmitting information, underlying and situational stress and emotions can
cause us to focus only what we want to say; however,
communicating with others is less about talking ourselves and more about listening to others. There is a
huge difference between engaged listening and simply
hearing. Listening to others means more than under-

standing the words being communicated. As you listen
carefully and engage with what is being said, you will
hear subtle intonations in the speaker’s voice that tell you
how that person is feeling and what emotions he or she
is trying to convey. Understanding non-verbal communication can also help you connect with others, because
the way someone looks, listens, moves and responds to
another person says more about how he or she feels
than words.
Regardless of the type and mode of communication
or the communication participants (patient communication, in-office/team communication, communication
between the dentist and the dental laboratory), effective
transmission of information (whether through speech,
writing or electronically) is critical to obtain a successful
treatment outcome. In the digitalised world we live in,
transmission of information seems easier than ever,
because it often takes only one click to send, forward or
receive a message. However, the importance of nonverbal communication should not be under-estimated.
Direct expression of thoughts or needs makes communication clear, but it is only effective if combined with
engaged listening and skilful reading of emotions, leading to the expected results. Effective communication is
always about understanding the other person, not winning an argument or imposing your opinions on others,
whether at home or in the workplace.
Sincerely,
Magda Wojtkiewicz
Managing Editor

CAD/CAM
2 2022

[4] =>

| content
editorial
Importance of effective communication

03

news

page 16

Preferences for fixed restorations and resulting impact
on the US and European overdenture markets
Global healthcare systems unprepared
for another pandemic, research shows
Artificial intelligence may automate design of biomimetic
single-tooth prostheses

06
10
12

opinion
Dental Thermal App offers “a simple, yet intuitive,
clinically based workflow”
Both digital and analogue dental workflows
need to be your best friend!
page 34

14
16

patient communication
Help your patients say yes!

18

case report
Complete rehabilitation with guided surgery:
Focus on temporary restoration
Digital procedures for the design of a sequential occlusion
in a complex clinical case
A chairside CAD/CAM lithium disilicate block
in the hands of the dental technician: Giving that extra touch
page 38

21
24
34

industry report
Transforming dentistry with groundbreaking technologies

38

interview
“Dentsply Sirona World provides a
window into the future of dentistry, which is digital”

42

trends & applications

Cover image courtesy of
Yalcin Sonat/Shutterstock.com
2/22

issn 1616-7390 • Vol. 13 • Issue 2/2022

50

manufacturer news

52

46

features
Building a sustainable dental practice

58

meetings
In-person IDEM 2022 provided forum
for robust exchange of ideas
Exhibitors stack up for IDS’s centennial event in 2023
International events

international magazine of dental laboratories

60
62
64

about the publisher

case report

A chairside CAD/CAM lithium disilicate block
in the hands of the dental technician

opinion

submission guidelines
international imprint

Both digital and analogue dental workflows
need to be your best friend!

industry report

Transforming dentistry with
groundbreaking technologies

04

How 3D printing increases value for your patients
Traditional subtractive methods
required outrageous sums of money

CAD/CAM
2 2022

65
66

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| news

Preferences for fixed restorations
and resulting impact on the US and
European overdenture markets
© iData Research Inc.

Daniel Sussman and Dr Kamran Zamanian, Canada

In recent years, patient preferences for fixed restorations have driven significant growth in both the US and
European fixed-hybrid overdenture markets. This trend is
particularly pronounced in the US, where patient awareness has also been a significant factor in recent years.
Though it was slowed momentarily by the COVID-19 pandemic, this market has made a full recovery and is set to
experience single-digit growth moving forward.
Fixed-hybrid overdentures are full-arch restorations that
use an implant bar into which the dentist screws the denture prosthesis and, therefore, they cannot be removed
by the patient. This makes them similar to natural teeth
and eliminates much of the hassle of regular maintenance.
As a result, the proportion of patients seeking a fixedhybrid restoration has soared across the US and Europe
despite their premium price tag. During the pandemic,
there has been a rise in demand for more affordable

CAD/CAM
2 2022

options such as implant-supported overdentures, but
the fixed-hybrid overdenture market has now recovered
and, as can be seen in Figure 1, is set to grow steadily
in the coming years.

Fixed attachments gaining ground
The growth of the fixed-hybrid overdenture market as well
as that of the total overdenture market has had a positive
impact on both implant bar and attachment markets.
In 2016, Zest Dental Solutions launched its Locator F-Tx
fixed attachment system. This system operates as an alternative to screws and cement, and has created significant
value in the attachment market. Zest’s fixed attachment
system has experienced significant growth, as the system has been used to secure an increasing number of
fixed-hybrid overdentures. Whereas Zest Dental Solutions’
Locator F-Tx currently dominates the fixed attachment

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overdentures such as fixed-hybrid overdentures and removable implant bar overdentures, since the implant bar
is a key component of these overdentures.

market, other minor competitors exist, such as the
Smileloc system. Naturally, the fixed attachment market
not only benefits from a steadily increasing rate of adoption
but also from being tied to the fastest growing segment
within the overdenture market.

A shifting landscape
for the implant bar market
Like the attachment market, the implant bar market is
also undergoing substantial changes that will affect it
in both the short and long term. The first such change
relates to the market’s competitive landscape. The implant
bar market can be broken down into implant bars manufactured by dental laboratories and those manufactured
in independent milling facilities. Traditionally, there was
a near-even split between dental laboratories and milling
facilities in the US; however, dental laboratories command
a significantly higher share of the market in Europe, particularly in Italy, Spain and Portugal. Recently, the growing
use of CAD/CAM technology has increased efficiency
in the milling process and decreased the cost. Hence,
smaller dental laboratories are now able to produce their
own implant bars inexpensively, substantially increasing
their share of the implant bar market.
The competition between milling facilities and dental
laboratories, in addition to the increased efficiency and
cost savings of CAD/CAM technology, have combined to
place downward pressure on implant bar prices across
the US and Europe. As CAD/CAM technology becomes
more accessible, an increasing number of dental laboratories have begun in-house manufacturing of implant
bars. The increased efficiency of this process has caused
the cost per implant bar to decrease. Whereas dental
laboratories and CAD/CAM milling facilities are interested
in maintaining their profit margins, reduced costs present an opportunity to capture greater market share. As
a result, the price of implant bars has been decreasing
while the use of CAD/CAM technology increases. This is
expected to reach a plateau as the implant bar market
becomes saturated with CAD/CAM milling. These price
reductions also have an impact on the pricing of splinted

CAD/CAM
2 2022

Another current trend within the implant bar market
regards the materials being used in their fabrication.
Implant bars in both the US and Europe are primarily fabricated with titanium, cobalt chromium or, occasionally,
gold. In the US, the use of titanium has been most popular whereas in Europe, cobalt is used more often. Both
titanium and cobalt chromium have benefits. Cobalt has
been used in dentistry for decades and is a very strong,
biocompatible material with high corrosion resistance.
Titanium is also a very strong and corrosion-resistant
material. Where titanium distinguishes itself, however,
is through its lightweight nature, elasticity and superior
biocompatibility. In the implant bar market, titanium has
been gaining considerable popularity, mostly owing to its
biocompatibility. Germany, Scandinavia, Austria, Switzerland and the Benelux region have paved the way in the
use of titanium in Europe. Cobalt chromium still commands a significant unit share of the implant bar market
in France, the UK, Italy, Spain and Portugal, but titanium
is expected to become the dominant implant bar material
in these countries over the next decade (Fig. 2).

Closing thoughts
In summary, shifting patient preferences towards fixedrestorations and the widespread adoption of CAD/CAM
technology has led to significant changes in the overdenture market. Whereas the future may be uncertain,
iData Research forecasts indicate that this market is
expected to experience substantial growth over the next
five to ten years across Europe and the US. This will be
spearheaded by remarkable growth within the fixed-hybrid
overdenture, implant bar and fixed attachment markets.

about
Daniel Sussman is a research analyst at
iData Research. He develops, writes and
models syndicated and custom research
projects for various medical device
industries. To date, he has published the
company’s European gastrointestinal
endoscopic devices report as well as its
US and European dental overdentures series.
Dr Kamran Zamanian is CEO and
founding partner of iData Research.
He has spent over 20 years working in
the market research industry with a
dedication to the study of dental implants,
dental bone grafting substitutes, prosthetics,
as well as other dental devices used in
the health of patients all over the globe.

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| news

Global healthcare systems
unprepared for another pandemic,
research shows
By Dental Tribune International
A survey commissioned by the World Innovation Summit
for Health (WISH) has found that healthcare systems in
both developed and developing countries would not be
prepared for another pandemic, should one emerge in the
next five years. As well as reporting this lack of preparedness, the healthcare workers surveyed cited a shortage of
financial support and qualified staff as factors that could
expose healthcare systems to the danger of collapsing in
the event of another global health emergency.
The survey asked healthcare professionals in Brazil, India,
Nigeria, Saudi Arabia, the UK and the US about their workplace and profession and sought to gain an insight into the
impact that the SARS-CoV-2 pandemic has had on their
lives. Nearly half (49%) of all respondents said that a lack
of preparedness is one of the greatest threats facing their
national health system. When respondents were asked about
the factors that may leave health systems vulnerable to
collapse in the event of a new pandemic, 60% identified
a lack of financial support and 55% pointed to a shortage
of trained professionals. An inability to provide sufficient
support to patients was identified by 44% of respondents
as posing a significant threat to national health systems.

Afdhal continued: “The current pandemic has strained
health systems to create urgent response measures such
as increasing capacity, enhancing infection control, moving
to remote models of care, and enabling mass vaccination,
among others. There is a need to take stock of the challenges and for enablers to respond at a national level, as
well as create opportunities for accelerating the sharing of
strategies internationally.”
A WISH report published this year sought to identify the
gaps in healthcare systems that were exposed during the
SARS-CoV-2 pandemic and proposed recommendations to
governments and policy makers in order to shore up their
healthcare systems. According to the report, short-term
actions that governments should take include developing
multisectoral preparedness plans with key objectives and
responsibilities. In the medium term, governments should
identify weaknesses that were exposed during the current
pandemic, adapt care models, improve information systems and strengthen the workforce. In the longer term,
structural and regulatory changes should be made in order
to improve health system resilience.

© elenabsl/Shutterstock.com

In a press release, WISH CEO Sultana Afdhal commented:
“Our findings spotlight some of the critical challenges that
the COVID-19 pandemic has forced upon us over the last
two years, and which those that care for us are still trying
to mitigate today. As an advocate for a healthier world

through global collaboration, we urge governments, industry
leaders, and policymakers to take these insights and work
towards building next-generation health systems that are
better equipped to meet similar challenges in the future, in
order to improve the standard of care and, crucially, to ease
the burden felt by our healthcare workforce.”

10

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2 2022

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| news

Artificial intelligence may
automate design of biomimetic
single-tooth prostheses
By Franziska Beier, Dental Tribune International
Even with the support of modern CAD/CAM technology,
creating a dental prosthesis is still rather time-consuming,
resulting in more chair time and high costs for patients. To
facilitate the design of molar crowns, researchers from the
Faculty of Dentistry at the University of Hong Kong (HKU)
and the Department of Computer Science of Chu Hai College
of Higher Education in Hong Kong collaborated to develop
a novel approach using artificial intelligence (AI).
When asked what inspired the research, lead author Dr Walter
Yu Hang Lam, clinical assistant professor in prosthodontics at the Division of Restorative Dental Sciences at HKU,
told Dental Tribune International: “Some patients sense
a very subtle hair-thin high spot on their dental prosthesis.
Therefore, in the dental curriculum, a significant proportion
of time is dedicated to occlusion theory and clinical training
to provide a dental prosthesis that fits the patient’s mouth.
My colleagues and I hoped to figure out a solution for
improved treatment efficiency and patient experience.”
In order to restore the patient’s original appearance, masticatory function and general oral health, dental protheses should
have the same occlusal morphology and 3D position of the
natural teeth. These can be deduced for a missing tooth from
those of the surrounding dentition because the teeth of an individual are all controlled by the same set of genes and exposed
to the same oral environment. The researchers hypothesised
that AI could thus generate the design for a single-tooth prothesis
based on the characteristics of the remaining dentition.
The research team used a machine learning approach called
a generative adversarial network (GAN) to train and validate
their AI system and have tested it on 175 participants. The
system was able to reconstruct the shape of a natural tooth
and automate the process of dental protheses design based
only on the digital model of the patient’s dentition.

“The 3D GAN algorithm was selected due to its superior performance on 3D object reconstruction compared with other
AI algorithms. In the preliminary study, 3D GAN was able
to rebuild similar shapes to the original teeth for 60% of the
cases. It is expected to mature with more AI training data,”
commented co-author Dr Reinhard Chun Wang Chau,
research assistant in the Division of Restorative Dental
Sciences and of Applied Oral Sciences and Community
Dental Care at HKU, in a press release. For future research,
the team proposes to investigate whether the presence of opposing teeth will help the AI to generate a more natural tooth.
Asked about the advantages of this method for dental professionals and patients, Dr Lam said: “It’s less time-consuming
for both of them. Dentists will spend less time on registering
jaw relationships and chairside adjustment, greatly facilitating
the entire treatment process and enabling them to take on
more cases.”
He continued: “Patients will spend less time and money on
the treatment. In addition, the dental prostheses they receive
will fit better to their remaining dentition and are thus less
likely to cause jaw problems.”
According to Dr Lam, the research group hopes to make
the AI technology available for dental professionals within the
next five years, after having tested its accuracy further in
simulated and clinical scenarios. Moreover, the researchers
believe that the method may be applied to the fabrication
of crowns for other teeth and of multi-unit restorations in
the future.
Editorial note: The study, titled “Artificial intelligencedesigned single molar dental prostheses: A protocol of
prospective experimental study”, was published online on
2 June 2022 in PLOS ONE.

In a recent experimental study, Hong Kong researchers demonstrated that their AI system could g enerate the design of a molar (red) based on the features
of the remaining dentition (dark grey). (Image: © HKU)

12

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| opinion

Dental Thermal App offers “a simple,
yet intuitive, clinically based workflow”
An interview with Dr Les Kalman
By Iveta Ramonaite, Dental Tribune International

Dentistry, just like other med
ical fields, is not immune to
digital disruption, and significant
technological advancements
have taken place in recent de
cades. Dr Les Kalman is an as
sistant professor in restorative
dentistry at Western University
in Canada and a researcher
with a dedicated focus on
innovation in medical devices
and technologies, and in this
interview with Dental Tribune
International, he discusses the
benefits of developing new

tools and workflows to ad
vance healthcare. He also talks
about his novel dental soft
ware, the Dental Thermal App,
and explains how it could
enhance the clinical experience
of dental professionals.
Dr Kalman, what is thermog
Dr Les Kalman.
raphy, and what use does it
have in dentistry?
Thermography is a process whereby a thermal camera
captures and produces an image by using infrared
radiation emitted from an object. The image provides
an opportunity to visibly record infrared energy or heat
that is invisible to the human eye. Thermography is a
non-invasive, non-contact and portable imaging method.
It has been used in various industrial fields, such as
engineering and construction.
Thermography is now an evolving field in medicine, and
its use as a possible diagnostic tool is being investigated.
It is currently used to aid in the diagnoses of vascular
malformations, thyroid nodules and different intra-ocular
tumours.
Thermography has had only limited use in dentistry until
now but, with recent advances in technology, it has
been employed to assess changes in the temperature of

14 CAD/CAM
2 2022

restorations, to monitor inflamed
periodontal tissue and disease
of the temporomandibular joints
and to identify intra-osseous
temperature changes during
dental implant placement.
Thermography has also recently
been used to monitor inflam
mation after dental surgeries
and has shown promise as a
tool to diagnose pathological
conditions.
What motivated you to de
velop the dental thermal
app, and what specific ap
plications does the app have
in dentistry?
My motivation has always been
to improve the clinical experience
and explore new possibilities.
Our research has focused on
the development of medical
devices and mobile technolo
gies to provide novel workflows and applications. At a
pre-pandemic Consumer Electronic Show where we were
pitching our SmileShade app, I had the opportunity to
meet and engage with the Teledyne FLIR team, who are
arguably the leaders in thermography. After some dis
cussion, it was apparent that FLIR did not have a dental
application. And so, the collaborative relationship began.
We worked for several years to develop the software. Its
initial application was aimed at additive manufacturing
and 3D printing as a novel method to assess the fit of
printed implant bars with dental implants. As we ex
panded testing, we soon realised that there were so many
other possible applications in dentistry and teledentistry.
We have explored a few notable applications. These in
clude using the thermal app as an alternative method
for visualisation, providing an unconventional method of
identification and assessment of the patient’s surface

[15] =>

opinion

According to Dr Les Kalman, thermography can facilitate novel clinical workflows and will be gaining increased use in dentistry. (Image: © Les Kalman)

temperature and temperature generated from surgical
procedures. Another possible application is in infection
control. Hard surfaces can be imaged to assess disinfection and the fit of KN95 masks can be assessed. The thermal app can be used in education to assess procedural
metrics. It can also be used to evaluate the fit of prostheses.
We are thrilled to have had the app approved by the
Teledyne FLIR Developer Community and Google Play!
Why should dental professionals be excited about
this technology, and how will it facilitate clinical
workflows?
Digital dentistry is exciting, and there have been remarkable developments in image acquisition, digital design and
output. Technology can improve the clinical experience for
both the patient and clinician while maintaining or exceeding the standard of care. That is exhilarating! I hope that
clinicians and technicians welcome the new technologies
with open arms and assess their value in their workflows.

Digital technology continues to change the future of
dentistry, offering novel ways to diagnose dental
conditions and plan treatments. How did these advancements shape your career as a dental professional, and do you think that change always equals
progress?
As a lifelong technology enthusiast and a researcher in
the dental device space, I believe advancement is the
key. If advancements can improve efficiency and patient
experience and reduce costs, then that is a win-win
situation for both the clinician and the patient. These
advancements also have the opportunity to improve
sustainability and accessibility for patient care. These
factors foster passion and excitement, and that fuels
my career!

“Dentistry needs
to be well represented
on the tech stage.”

We developed the Dental Thermal App with a simple, yet
intuitive, clinically based workflow. It provides the tools
needed for a novel approach to imaging and the appropriate documentation. How this technology will have an
impact on clinical workflows is the most important question. The pandemic has disrupted dentistry and steered
us to a digitally connected space. There is now a remarkable opportunity to explore this space by developing
new tools and workflows to expand the connected oral
healthcare platform.

Change does not always equal progress. We have to
evaluate all drivers of change and ensure that the standard
of care is maintained, sustainability is improved and that
new ideas are supported by scientific evidence. But let
us not be too rigid, as change has to start somewhere,
and not all new ideas are bad ideas.

Are there any challenges that may impede the use
of the app by dental professionals?
Change is always a challenge. Dentistry is grounded on
tradition and history. Many people, including clinicians,
do not like to change their way of doing things. However,
we should be mindful of new technologies and workflows
that may improve the clinical experience. Any new technology will require evaluation, feedback, revision and
support from the dental community. Keeping an open
mind and being aware of possibilities is crucial. If we think
back to the original iPhone, we will realise that technology
evolves as we embrace it.

Would you like to add anything else?
I would like to stress that the more tools we have in our
toolbox, the better. Tools provide alternative methods of
imaging, assessment and documentation. However, they
cannot be a substitution for principles and fundamentals.
They are just tools, and as clinicians, we need to know
when to use them. However, let us not fear technology
but embrace it. Dentistry needs to be well represented
on the tech stage. Just think back to film cameras, and
consider how taking pictures and recording videos has
evolved. Let us bring this evolution to our profession in
the hope of improving the clinical experience!

CAD/CAM
2 2022

[16] =>

| opinion

Both digital and analogue dental
workflows need to be your best friend!
Dr Michael D. Scherer, USA

they? Computers help people spell better and write in a
more grammatically correct manner. Using computers,
people may not have become any more creative, but they
certainly have become more efficient. Has this freed them
up to be more expressive and inventive with their writing?
Dentistry is at a similar crossroads. Digital dentistry techniques will not necessarily make you a better dentist or
more creative overnight, but in my experience, they will
improve your technique, and make your dentistry more
predictable and efficient, just like the word processor did
for writers.

Scan of the maxillary prosthesis and the opposing arch.

Many of the world’s greatest literary achievements
were created with a pen or typewriter. And then, along
came computers and word processing software such
as Microsoft Word and Apple Pages. Did anyone notice
an improvement in storytelling? Maybe it got faster, but
digital tools did not expand anyone’s imagination, or did

I have heard many dentists complain that digital technology cannot make you a better dentist. In my opinion, that is not the case. I know because I am proof.
I am just an average clinical dentist, but because of
digital pathways, I can do things in dentistry that I could
never imagine doing, and I can do the basic tasks
effortlessly.

It should not be a question
of one over the other
When it comes to dentures, implants and full-mouth
reconstructions, digital pathways have made my work
more predictable and time-efficient, but I am not ignoring analogue techniques because I employ more digital ones now. Ever since adopting intra-oral scanning
almost ten years ago, I have only made a small handful
of physical impressions for routine crown and bridge
cases, but I still use analogue workflows for larger
cases.
Analogue and digital workflows are like good friends,
especially for complete dentures and implant workflows.
They just work together. When dentists ignore digital
pathways because they believe it can only be one or the
other, they are mistaken.

Scanning of the mandibular prosthesis.

CAD/CAM
2 2022

I am a better digital dentist because of my analogue
mindset. In my mind, the digital pathways that I take are
no different from the analogue workflows, except that
I eliminate the polyvinylsiloxane. In addition, digital technology enables me to leverage the data I collect for design and production or, at the very least, share it more
easily with a treatment partner.

[17] =>

opinion

In a denture workflow, for example, you can choose
the analogue workflow, taking a traditional custom
tray impression using polyvinylsiloxane, or the digital
one, using an intra-oral scanner. You scan the identical arch, do a fully digital design, but ultimately, you
get to that same point as you would with a physical
impression.
Our inclination is to separate digital and analogue workflows, to treat them as if they are competing, but I argue
that there is no such thing as a 100% digital dentist, just
like there is no longer a need for a 100% analogue mindset. Our clinical reality is that we should be thinking about
how analogue and digital can live together.
Studies have clearly documented that digital pathways
for any number of indications are at least as accurate as
analogue.1 I am not sure that anyone would argue about
which one is faster or more comfortable for the patient.
But again, I am not saying you need to choose one over
the other. I think we should be taking advantage of both
digital and analogue techniques to provide the optimal
treatment for our patients.

Making the case for digital
and analogue hybrid workflows
On my instructional website, learndentistry.com, you will
notice that nearly every one of the cases that I demonstrate utilises both analogue and digital pathways.
This is especially true for denture workflows when
the maxillomandibular relationship must be accurately
documented. You simply need to use an analogue technique to do this, for example a conventional wax recording technique. The studies I have reviewed have
not concluded that this can be done both accurately
enough and simply using a digital pathway—for now.
Once you determine the relationship, the occlusal rims
can be scanned and then you return to a digital workflow for design and production.
Likewise, beginning your denture workflow with an intraoral scanner has tremendous advantages too. Intra-oral
scanners capture oral tissue in a passive state. You create a mucostatic impression that can result in a much
better fitting denture, especially when your patient presents with thin, flat, sharp or flabby residual ridges. If you
are still one of those wondering whether you can accurately scan edentulous patients, the literature supports
that it can be done,2 and I know because I do it regularly
in my clinical practice.
I encourage you to go to my website or the 3Shape case
study page (www.3shape.com/en/case-studies) to review cases. There you will find real-world examples of
how the two pathways work together to provide terrific
treatments.

Dr Michael D. Scherer and his team.

If you are not using an intra-oral scanner at this point,
I suggest you consider it. You can get started with
simple crown and bridge workflows, send the cases to
your laboratory partner and, when you are comfortable,
expand your repertoire.
Going digital is not about learning new techniques; it is
about doing what you have always done, digitally. I will
say, however, that being digital means that you will need
to improve your tooth preparations, but that is a skill any
dentist could use, even if he or she decides to throw out
the scanner the next day and go back to conventional
workflows. To tell you the truth: once you get used to
intra-oral scanning, you will never go back to goo.

Editorial note: A list of references is available from the
publisher.

about
Dr Michael D. Scherer is an assistant clinical professor
at Loma Linda University in California and a clinical instructor
at the University of Nevada, Las Vegas and maintains a practice
limited to prosthodontics and implant dentistry in Sonora in
California, all in the US. He is a fellow of the American College
of Prosthodontists and has published articles, books, and
in-person and online courses related to implant dentistry,
clinical prosthodontics and digital technology with a special
emphasis on full-arch reconstruction. As an avid technology
and computer hobbyist, Dr Scherer’s involvement in digital
implant dentistry has led him to develop and pioneer new
CAD/CAM surgical systems, interactive CBCT implant planning,
outside-of-the-box radiographic imaging and digital design
concepts, and new approaches to 3D printing.

CAD/CAM
2 2022

[18] =>

| patient communication

Help your patients say yes!
Dr Kübel Özkut, Turkey

The last two years have certainly been challenging
times, and many of us have been understandably worried
about what it all means for the future of our businesses.
The additional weakness of systems that were already
struggling prior to the COVID-19 pandemic have become
even more magnified and that certainly is not helping us
regain our patient numbers.

18

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2 2022

Since the beginning of the pandemic, we as dental
professionals have put a great deal of effort into making our patients feel safe and protected so that they
can properly maintain their oral health by receiving any
necessary treatment. However, knowing how to execute
excellent dental treatment and having the opportunity
to provide treatment to our patients are two different

[19] =>

© sirtravelalot/Shutterstock.com

patient communication

|

nity to make improvements to our systems to raise case
acceptance rates.
If we want patients to accept treatment, we need to fully
understand what it is they really desire. When we have
the same priorities as our patients, our practices’ retention and case acceptance rates will go up. Patients will
feel more in control of the process and appreciate that we
have really understood their needs and values—thereby
fostering loyalty and trust.2 They will not feel pressured
into accepting treatment they do not really want. Instead,
they will gladly accept treatment that will help them meet
their oral health goals.

Engagement with patients
Effective listening is the key to finding out what motivates
patients, what they think about their smiles and what it
is that they would like to improve.3 It is not about selling
dentistry; it is about getting to know our patients and
even partnering with them so that we can create a winwin situation. Asking questions, particularly open-ended
ones, can help encourage patients to communicate their
oral health-related desires; for example:
– On a scale of 1–10 (1 being poor and 10 being
excellent), what level of oral health would you like to
achieve?
– Have you ever encountered problems with chewing,
or have you had mouth or tooth pain?
– How important is your smile to you and to your confidence when interacting with people, both personally
and professionally?
– If you had a magic wand, what would you like to change
about your smile, if anything?
– Diet affects oral health. Could you please tell me about
your diet?

things. Getting patients to schedule the treatment we
recommend can be difficult, but it is vital to our practices’ success. The acceptance rate should be greater
than 80% for existing patients and between 50% and
75% for new patients.1
It is imperative to take the time to explain to each patient
why he or she needs the particular treatment, and we
must do our best to answer all of his or her questions.
Despite receiving all the necessary information concerning
the proposed treatment, many patients leave the office
without scheduling an appointment for the treatment—
some never to be heard from again. While this can be
quite a frustrating situation, it can also be an opportu-

We dentists may be excellent clinicians and superior
at treatment planning, but presenting treatment plans
to the patient is something better delegated to a welltrained staff member. For example, having a treatment
coordinator who goes over every detail with the patient
in a comfortable, quiet environment, giving him or her
the opportunity to ask questions without feeling rushed,
can be very effective.
Conversations supported with digital tools to demonstrate treatment options visually also help patients
understand the benefits of the suggested treatment
and help them feel more connected to the practice,
which of course makes them more comfortable about
scheduling treatment. If we want to improve case
acceptance in our practice, we should ask for the patient’s final decision after presentation of the suggested
treatment and explore any barriers to acceptance with
the patient.

CAD/CAM
2 2022

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| patient communication
Dental fears

Efficient recall and retention programme

Unfortunately, dental fears are common and often keep
patients from getting the treatment they need. When
patients look at before and after photographs of similar cases we have completed, it can help to ease their
fear and earn their trust, making them much more likely
to accept the treatment. It is imperative that the patient understands exactly what the treatment involves
and how we plan to keep him or her comfortable. This
includes enquiring about his or her concerns, covering the possible consequences of not receiving treatment and focusing on the advantages of the proposed
treatment.

Retaining a current patient is far easier and more costeffective than attracting a new patient, so investing time
and effort in an efficient patient recall and retention
strategy is essential. In an effective recall and retention
programme, patients should visit twice a year.

Research has found that nearly 68% of those who avoided
or delayed visits to the dentist gave the expense as the
primary reason.4 While multiple reasons were given, the
cost of going to the dentist was mentioned more than
twice as often as anything else.4 Most patients do not
put money away specifically for dental care and have
no idea how they are going to pay for treatment.5 In my
experience, if they are not in pain, patients often convince
themselves that they do not need treatment, which inevitably leads to more complicated problems and additional
costs down the road.
We should take the time to educate patients in detail before talking about costs, making sure that they
understand the value of the care we provide. If it is
because they do not really see the value of the treatment, we should educate them about their condition
and the possible consequences of not receiving the
treatment. Once patients understand why they need
treatment, price becomes less of a barrier. In our clinic
policies, we should offer different financing options for
our patients, showing them that we are also ready to
support them.

Lack of time
Lack of time is a common reason for treatment delay.
Like most people, our patients are often very busy and
may forget to call to schedule treatment once they leave
the practice, sometimes despite knowing the importance
of their dental health and the importance or urgency of
the proposed treatment. To overcome this, we can train
our treatment coordinator to follow up with the patient
two days or a week after the initial case presentation
is made. That way, the conversation is still fresh in the
patient’s mind.
We can use these calls as an opportunity to educate patients even further and address any lingering concerns.
Patients will appreciate the extra effort and gain a better
understanding of the recommended treatment and why
it is necessary.

CAD/CAM
2 2022

The recall and retention strategy should involve making
patients aware of the practice’s services and the value of
the ongoing care that the team provides. This includes
the amazing advancements in dental materials and
digital technologies and the treatment options available.
It is important to emphasise the improved patient experience and faster results that can be achieved with
these tools.
In summary, an efficient, structured case presentation
policy ensures that patients say yes to our treatment
plans. It also addresses one of the core values of dentistry, which is commitment to oral health as a component of the general health of our patients. When we gain
and retain patients who value our practice, we will have
the opportunity to practise with less stress and more joy
in our clinics.

Editorial note: A list of references is available from the
publisher.

about
Dr Kübel Özkut graduated in dentistry
from Istanbul University in Turkey
in 1996 and received her MBA with
a focus on healthcare management
from Yeditepe University in Turkey
in 2003 and her master’s degree in
prosthodontics, aesthetics and digital
dentistry from the University of Siena
in Italy in 2020. She is an adjunct
professor of business and administration at the dental school
of the University of Siena, teaching in its residency master’s
programme in prosthodontic sciences, and is a visiting lecturer
at Acıbadem University in Istanbul. Since 2009, she has
been the clinic director of the dental department of
Acıbadem Health Group’s Maslak Hospital in Istanbul.
Her special interests are aesthetics, advanced restorative
and digital dentistry. She also gives consultations and
lectures on the management of healthcare organisations.
Dr Özkut is the president of the Turkish Academy of Esthetic
Dentistry and a scientific committee member of the European
Academy of Digital Dentistry, European Association for
Osseointegration and European Society of Cosmetic Dentistry.

[21] =>

case report

|

Complete rehabilitation
with guided surgery:
Focus on temporary restoration
Drs Francesco Zingari & Francesco Gallo, Italy

Introduction
The case described here concerns a 56-year-old patient
with no contributory medical history. She presented with
a metal–ceramic maxillary bridge from tooth #17 to tooth
#25. Most of the abutment teeth had undergone endodontic treatment and had been restored with a root
post. The patient’s anamnesis included dislodgements
and considerable pain when chewing. The clinical and
radiographic examinations revealed caries at numerous
areas, which had undermined the prosthetic work (Fig. 1).

Treatment plan
The treatment plan started with the removal of the prosthetic restorations in order to assess each abutment tooth
individually, revealing the presence of non-preservable
residual teeth. The treatment plan required the extraction
of all the maxillary teeth and their replacement with six
implants in the scope of guided implant surgery. The implant positions were planned virtually so that the implant

1
Fig. 1: Initial situation on the panoramic X-ray.

bed preparation and insertion could be carried out using
a surgical guide. In order to enable immediate restoration,
by means of computer-aided technology, a temporary
denture was designed and fabricated before beginning
treatment.

2
Fig. 2: Planning restorations in CAD software guarantees high precision.

CAD/CAM
2 2022

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[22] =>

| case report

3
Fig. 3: Implant analogues on the model, the temporary denture milled from composite and the surgical guide.

Steps of the prosthetic restoration
First, both jaws were digitally recorded with an intra-oral
scanner. A CBCT scan with an inserted radiographic
guide (Universal Stent, Media Lab) followed this. The
guide optimises the matching of the acquired STL data
(model) and DICOM data (CBCT) for implant planning.
The digital matching took place after the dental technician had worked out a diagnostic wax-up on the virtual
model (created on the basis of the intra-oral scans).
For this, both the STL data from the CAD software and
the DICOM data were then imported into the implant
planning software and superimposed to obtain an exact
virtual representation of the surfaces in the mouth, the
wax-up, and the bony structures and nerve pathways.
With the help of this imaging and the possibility of analysing
the quantity and quality of the bone, the optimal implant

positions could be determined from an anatomical and
prosthetic point of view (Fig. 2).
Once the planning was complete, the software automatically created a suitable surgical guide, which was sent to
a 3D printer as an STL data set and manufactured from
resin using the printer. The drill sleeves inserted manually
into this guide served as 3D guiding elements in all surgical steps, from preparing the implant bed to inserting
the implants. The advantages of guided surgery are
manifold. In the present case, the precise planning and
implementation of the implant positions enabled, before
surgery, the virtual design and milling of a temporary
denture for immediate loading.

Production of the temporary denture
In an initial step, the implant analogues were positioned
in the master model with the aid of the surgical guide
and the connections fixed in place with a force of 5 N.
Afterwards, the master model was scanned with the
screwed-in implant analogues.
To design the temporary denture, the STL data sets were
imported into the CAD software and the original virtual
models with diagnostic wax-up were superimposed on the
scanned models with implant analogues. In this way, it was
possible to construct a temporary denture that met the
diverse requirements of an immediate restoration with immediate loading and that corresponded exactly to the planning. The temporary denture was milled in composite (Fig. 3).

Material

4
Fig. 4: Preserved precise marginal fit of the temporary denture.

CAD/CAM
2 2022

The requirements for the material from which a multiunit implant-supported, immediately loaded temporary
denture is to be made are challenging. Above all, the
material must have a high fractural strength, but should

[23] =>

case report

5
Fig. 5: Milled temporary denture, cleaned and polished.

also have a suitable modulus of elasticity and must
be abrasion-resistant. Structur CAD (VOCO) is a composite disc that, thanks to its mechanical properties,
enables the fabrication of immediately loadable temporary dentures without a metal framework that can
withstand high masticatory loads. An analysis of the
material properties shows a failure load of 741 N, a
three-point flexural strength of 136 MPa and a modulus
of elasticity of 4.4 GPa. Structur CAD is processed with
special diamond burs that, using appropriate milling
strategies, allow the highest precision to be maintained and
achievement of the details designed with the computeraided technology. Precise marginal fit is preserved (Fig. 4),
and the excellent adhesion between the composite and
the available composite luting materials for definitive restorations ensures a strong bond between the temporary
denture and connectors. If the two components were to
separate, this could compromise both the osseointegration of the implants and the stability of the soft tissue.

Surface shades
The surface of the temporary denture (Shade A2) was
clean and already polished after milling with diamond
tools, but it was sandblasted and treated with an adhesive
to ensure the adhesion of additional surface colours,
which were finally fixed on to the temporary denture by
light polymerisation. The use of these shades allowed retention of the virtually modelled morphology and achievement of optimal and individual final aesthetics (Fig. 5).

Final phase
As soon as the implants had been placed to the correct
torque according to the planning and with the help of
the surgical guide, the temporary denture for immediate
loading could be inserted (Fig. 6). A passive fit was
achieved right away, so it was possible to directly screw

the temporary denture on to the implants. For the patient,
the temporary denture alone led to a considerable
improvement in her quality of life.

6
Fig. 6: Temporary denture in the patient’s mouth.

about
Dr Francesco Zingari
is a dentist specialised in oral surgery.
He works in the oral and maxillofacial
surgery department at the
IRCCS Galeazzi Orthopaedic Institute
in Milan in Italy.

Dr Francesco Gallo is a dentist
specialised in oral and maxillofacial
surgery. He works in the oral and
maxillofacial surgery department at the
IRCCS Galeazzi Orthopaedic Institute
in Milan in Italy.

CAD/CAM
2 2022

[24] =>

| case report

Digital procedures for the design
of a sequential occlusion
in a complex clinical case
Dr Mario Perotti, Maurizio Melano & Marco Marzolla, Italy

1

2

4

5

Introduction

on the contrary, they show great individual variability. The
design of a new occlusion can be approached according
to the criteria expressed by different schools of thought:
some of them consider the use of a canine-dominant
occlusal function, others the construction of group functional guidance, and still others the construction of a
bilateral balanced occlusion. The gnathological school
of Prof. R. Slavicek envisions the programming of a
canine-dominant occlusal sequential function.

The average lifespan of the human population has been
increasing for many years, and this has led to an increasing number of patients developing malocclusion
and parafunctional habits, subsequently causing wear
or fracture, the introduction of incongruous dental treatments, and loss of teeth.
Anyone who deals with cephalometry knows that the
morphology of the skull and the conformation of the occlusion are not visible at average values in the population;

6

24

3

Whichever occlusal set-up the clinician considers correct for
his or her clinical case, it remains a dentist’s duty to provide

7

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[25] =>

case report

|

8

9

11

13

10

12

14

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25

[26] =>

| case report

15

16

the dental technician with all the necessary data for the construction of a new occlusion, such as the inclination of the
occlusal plane, the vertical dimension of occlusion (VDO),
and the values of the posterior and anterior determinants
of the occlusion, such as the values of the sagittal condylar
inclinations, of the Bennett angles and of the incisal guides.
The aim of this article is to report on the use of digital tools
in diagnosis, pre-therapy and therapy for the design of a
canine-dominant occlusal sequential function in a complex clinical case, which showed a loss of VDO, the loss
of some teeth and multiple fractures of existing prosthetic
restorations. In this instance, careful planning of the occlusal function, while respecting the patient’s anatomy,
led to tissue healing, the maintenance of neuromuscular health, and the proper and lasting integration of new
prosthetic restorations.
The accurate programming and waxing of a caninedominant occlusal sequential function requires great

17

26

expertise in design and technical execution. The purpose
of this paper is to present our use of digital procedures
in diagnostics path, with reference to CAD occlusal programming and the construction of prosthetic structures
through CAM, with the aim of simplifying the management of a complex workflow. This leads to greater
occlusal design customisation for an emerging group of
patients with impaired dental function.

Case report
A 66-year-old patient, with a medical history of noninsulin-dependent diabetes mellitus and ischemic cardiac
vasculopathy, presented for treatment of periodontal
abscess at the residual root of tooth #12 and multiple
fractures of the existing prostheses (Figs. 1–6). During
the visit, severe malocclusion was highlighted, as well as
loss of VDO, wear and fracture of prosthetic restorations
and residual teeth, and evidence of cervical abfraction.
The patient also showed modest muscle soreness on

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[27] =>

case report

palpation during the visit, especially in the medial and lateral pterygoid muscles, reduced opening of the mouth and
slight noise produced by the temporomandibular joints.

The articulator programming deriving from the axiographic record was then set as indicated by the
software (GAMMA Dental Software), both for the
regulation of the condylar and incisal guidance and
for the adjustment of sagittal condylar inclination and
Bennett angles (Fig. 21). The resulting prosthetic space,

Infection of the root of tooth #12, with 9 mm probing
depths, was immediately attributable to a vertical fracture (Fig. 7). Once the fractured root of tooth #12 had
been extracted, the patient would require fixed prosthetic full-arch rehabilitation, providing for as few endodontic and surgical procedures as possible. We agreed
on a full-arch prosthetic rehabilitation that would allow,
after studying the gnathological case and going through
interlocutory therapy with PMMA interim prostheses, the
definition of a sequential function at therapeutic reference position through a controlled increase in VDO and
stabilising jaw relations, then appearing conspicuously
compromised.

Therefore, cephalometric analysis was performed (Fig. 8)
based on a lateral radiograph (Fig. 9), and axiography of
border movements (CADIAX compact, GAMMA Dental;
Fig. 10) was recorded to set up an average-value articulator (Artex TR, Amann Girrbach), assembling stone
models with the facebow, to mill first interim prostheses
made at an arbitrary 5 mm VDO increase on the incisal
rod and improvement of overbite and overjet, for an
interlocutory pre-therapeutic purpose and immediate
aesthetic resolution.
Once the necessary causal periodontal and restorative
therapy had been completed, an intra-oral scan of
the arches (TRIOS 3 Pod, 3Shape; Figs. 11–14), and the
jaw relations with reference position wax were recorded
(Fig. 15). The scan images were printed in resin (VisiJet
RWT white, 3D Systems) with detachable abutments
using a 3D printer (ProJet MJP 2500 Plus, 3D Systems;
Figs. 16–18). The resulting models were plastered to
mounting blocks (Figs. 19 & 20) and mounted with reference position waxes and a facebow in a fully adjustable
arcon articulator (Reference SL, GAMMA Dental).

CAD/CAM
2 2022

[28] =>

| case report

22

23

24

25

at an adequate VDO expected for the rehabilitation of
vital anterior teeth whose anatomy cannot be further
modified was insufficient for a stable restoration of the
occlusal relations, particularly regarding the functional
tracks. It was therefore decided to use two red protrusion stops (+2 mm) to reposition the mandible on the
chosen therapeutic reference position (Figs. 22 & 23).
This would allow an improvement in the jaw relations,
a gain of prosthetic space in the premolar and molar
regions, and the maintenance of a prosthetic space
conforming to a correct anatomy for vital teeth #13 to 23.

27

26

28

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2 2022

The patient was then made aware of the updated
treatment plan: the purpose of planning a therapeutic
reference position rehabilitation was shown, and the
proposal to overlap the mandibular arch for the design
of a new occlusal plan was explained.
In this newly found therapeutic reference position,
the cones of the active centric occlusal relations were
shaped on the removable abutments of the mandibular arch. This relation of casts in therapeutic reference
position was then scanned with a desktop scanner

[29] =>

case report

28

29

31

|

30

32

33

(Xanos Evo Scan COMPACT, DENTAG; Fig. 24). The casts
were thus imported in the correct spatial position into the
CAD module (Virtual Articulator module, exocad DentalCAD, exocad; Fig. 25). Not having the virtual analogue of

the Reference SL articulator available in this CAD software, a virtual SAM articulator (SAM Präzisionstechnik)
system was set, because both of them are designed on
the same axioorbital reference plane and the geometry

34

35

36

37

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29

[30] =>

| case report

can be superimposed on the Reference SL. For the virtual
programming of the articulator’s functional parameters,
the output for SAM was re-executed from the electronic
axiography with GAMMA Dental Software (Figs. 26 & 27).
We then proceeded with the CAD modelling of the wax-up,
referring to the occlusal plane identified by the centric
cones scanned into the articulator (Fig. 28). The virtual
articulator allowed a first check of the occlusal relations
and allowed a sketch of tracking of the cusps with dynamic virtual instruments, allowing us to reach with our
CAD the sought morphology (Figs. 29–33).
The model was then milled in wax (CAD/CAM white
wax, YETI Dentalprodukte) with a five-axis milling ma-

CAD/CAM
2 2022

chine (CAM 5-S1, vhf camfacture), and the individually
detachable wax teeth were positioned on casts made
using 3D printing. The milled wax teeth were mounted on
their models, and the Reference SL articulator, already
properly programmed, was sent to the competent master
dental technician, who accurately shaped the functional
surfaces, according to Slavicek’s sequential functional
occlusal design principle, with differently coloured waxes,
highlighting the centric ratios, the mediotrusive and protrusive tracking functions, and the retrusive protection
(Figs. 34 & 35). The removable abutments allowed
modelling of the mediotrusive sequence with the incisal tables given by the axiographic registration (blue;
Figs. 36 & 37).

[31] =>

case report

47

|

48

49

The sequential wax-up was scanned with a desktop scanner
(inEos X5, Dentsply Sirona) and virtually captured. The virtual shape was rechecked in the CAD software for thickness,
connection and morphology, and for offset adjustments for
abutment adaptation. It was then sent for milling (CAM 5-S1)
of second interim prostheses made of PMMA with highstability ceramic micro-fillers (breCAM.multiCOM, bredent).

The finishing of the dental abutments was followed by
relining of the therapeutic reference position temporary
restorations—previously having protected of all functional
occlusal surfaces—and they were then finished and
polished. Teeth #33, 42 and 43 were reshaped in the
incisal area with direct composite additions, according
to the morphology designed during functional waxing.

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51

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31

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32

53

54

55

56

57

58

The clinical response confirmed the satisfying integration
of the prostheses from an aesthetic, occlusal, articular
and neuromuscular point of view, and the occlusal function was accordant with the plan (Figs. 38–42). The
patient used these second interim prostheses for eight

weeks, confirming good integration and suitable occlusal
function. This was verified with a second electronic axiography, which showed a good neuromuscular response to
the new occlusal design and to the modified mandibular posture in therapeutic reference position (Figs. 43–46).

59

60

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Finally, we provided the dental impressions for the
manufacture of the permanent zirconia prostheses.
The stone models were scanned with the inEos X5 and
the data sent to DentalCAD (Figs. 47–49), and a second scan was done with the patient’s temporary restorations positioned on the casts (Figs. 50–52). The
CAD software allowed us to match the scans so that
the one with the temporary restorations having been
used in therapeutic reference position, with sequential
occlusal function already completely programmed, was
now used to define the permanent teeth’s morphology
(Figs. 53 & 54) according to the planned jaw relations
(Figs. 55–58).
The permanent prostheses in zirconia (KATANA Zirconia
UTML, Kuraray Noritake Dental) were then milled (CAM 5-S1;
Figs. 59 & 60), and the dental technician performed the
layering and the finishing. Finally, they were cemented by
an adhesive procedure (PANAVIA V5, Kuraray Noritake
Dental; Figs. 61–65).

Discussion and conclusion
The diagnostic and technical workflow for the design of
a canine-dominant occlusal sequential function, inspired
by that described by Prof. R. Slavicek, with the aid of the
digital tools available today, proved to be convenient
for the clinician and the patient, allowing a reduction in
working time and procedural complexity.
Time spent in the functional diagnosis and in the design
of the sequential occlusion is in fact reduced, despite
the absence of dedicated CAD tools, therefore requiring some repetitive CAD modelling procedures to be
performed. The design of the obtained morphologies
allows the project to be milled in different available
materials as needed in shorter times and at lower
costs compared with the traditional procedures. Further
experience is needed for the refinement of an ideal procedure, and suitable CAD tools should be developed
for the purpose.

This procedure can however be applied to any type of
functional occlusion design—even canine-dominant occlusal function, group functional guidance or bilateral balanced occlusion, according to the clinician’s choices and
experience. The enormous advantage of scanning the
interim prostheses in therapeutic reference position after
a trial period is evident: acquiring the details of the true
function of the patient for the CAD analysis and check and
for milling the permanent prostheses in suitable material.

about
Dr Mario Perotti obtained his MD
and DDS from the University of Turin in
Italy and MSc in digital dentistry from
the University of Insubria in Italy.
He manages a private practice in Turin and
is a member of the research centre for
innovative technology and engineered
biomaterials at the University of Insubria.
He lectures internationally on digital
dentistry. Dr Perotti can be reached at drperotti@drperotti.it.
Marco Marzolla is a master
dental technician who specialises
in CAD/CAM. He lectures on digital
dentistry at the University of Insubria.

Maurizio Melano is a master dental
technician who specialises in occlusal
functional waxing and assembling
according to Prof. R. Slavicek’s school
at Danube University Krems in Austria,
where he attended a master course.

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A chairside CAD/CAM lithium d isilicate
block in the hands of the dental
technician: Giving that extra touch
Christian von Bukowski, Germany

1
Fig. 1: Fully crystallised lithium disilicate ceramic GC Initial LiSi Block for
single-tooth restorations in the dental laboratory.

CAD/CAM silicate ceramic blocks for the production of
single-tooth restorations such as crowns and inlays have
been available on the market for a long time. These are
mainly targeted at dental practices, but dental technicians also benefit from the potential of modern CAD/CAM
silicate ceramics in the form of blocks. GC Initial LiSi
Block is a fully crystallised lithium disilicate ceramic for
the production of single-tooth restorations that, from an
aesthetic point of view, are uncompromising in many respects, even to the critical gaze of a dental technician.
For decades, we as dental technicians have dealt intensively with the imitation of natural teeth. It is one of our

unique selling points and our personal merit to create
ceramic restorations with artistry that imitate the tooth
almost completely in shape and light optics. For some
years now, monolithic production with its many advantages has been the focus of interest and often gives rise
to a dichotomy. On one hand, we favour the manual layering of ceramics. With great attention to detail and the
subtleties of layering technology, we can create highly
aesthetic restorations that are difficult to beat in terms of
individuality. On the other hand, monolithic production is
economically attractive. Whether using pressing or CAD/
CAM manufacturing, monolithic production is in competition with the layering technique, especially concerning
posterior restorations. Silicate ceramics in particular have
high aesthetic potential. This is also of interest to dental
practices, particularly because CAD/CAM blocks made
of silicate ceramics promise the economical production
of aesthetic crowns, inlays, etc. In order to be able to
stake a claim on the production of single-tooth restorations in this changed environment, dental technicians
should ascertain the potential of modern CAD/CAM
materials in block form and, if useful, integrate them into
their everyday work.

A charming alternative to layering
Owing to economical, time-saving production, the laboratory remains competitive in the field of single-tooth restorations. The icing on the cake is that dental technicians
know how to achieve that bit extra from a restoration
through their particular expertise, attention to detail and

Fig. 2: The exact accuracy of fit and the homogeneous surface were impressive. Figs. 3 & 4: The crown looked very natural and required no reworking.

34 CAD/CAM
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craftsmanship than is possible in the vast majority of dental practices; in any case, this should be our conciliatory
claim as dental technicians because there are alternatives to the layering technique for the production of
ceramic restorations. However, the high bar set by the
layering technique still applies. The monolithic restoration
should satisfy the critical eye of the dental technician in
all respects. One material that meets this requirement is
GC Initial LiSi Block. Especially in the posterior region, a
fully crystallised lithium disilicate ceramic such as GC Initial
LiSi Block (Fig. 1) represents a charming alternative to
conventional production. Compared with zirconia, the
uncompromised versatility (anterior or posterior region,
monolithic or veneered), the high aesthetics and the
possibility of adhesive luting are convincing in the field of
single-tooth restorations. The ceramic, which is based on
the proven high-density micronisation technology, has
already conquered the hearts of many dental technicians
as a pressing material (GC Initial LiSi Press). Now the success story is being continued with a CAD/CAM block.

A short excursion into materials science
Lithium disilicate ceramics belong to the group of reinforced silicate ceramics. The starting product is glass,
in which corresponding crystals (reinforcing particles
such as leucite or lithium silicate crystals) grow through
controlled nucleation and crystallisation.1 Therefore,
such ceramics are called reinforced silicate ceramics.
GC Initial LiSi Block is an optimised or modified variant of
the classic lithium disilicate ceramic. The fully crystallised
lithium disilicate block possesses its final and optimal
physical properties without the need for firing and is thus
stable and fast to mill. GC Initial LiSi Block offers the
same biaxial strength (of 408 MPa) with or without firing.
The ceramic distinguishes itself from the other materials
of its class by its significantly refined crystals. Owing to
HDM technology, the crystals in the glass matrix are
smaller and more evenly and more densely distributed.
According to the manufacturer, this leads to a higher
wear resistance, precisely fitting margins and highly aesthetic results, which we can confirm from our everyday
laboratory work.
With regard to our targeted perfection, a monolithic
crown made of GC Initial LiSi Block can be given an extra
touch of naturalness with the GC Initial IQ ONE SQIN
concept—a paintable colour and micro-layering ceramic
system. It consists of three materials that are perfectly
adapted for use together, ensuring an efficient and
aesthetically convincing finalisation of monolithic and
buccally micro-reduced restorations. Colour and fluorescence are added with GC Initial IQ Lustre Pastes ONE.
These also serve as the connection firing for the SQIN
ceramics, which enable optimal creation of the desired
tooth shape with texture integration. Owing to their autoglaze effect, no additional glaze firing is needed. Both of

9
Fig. 5: The crown milled from GC Initial LiSi Block and finished without
additional firing. Fig. 6: Preparing the model for crowns #25, 34 and 35.
Fig. 7: CAD construction of the fully anatomical individual crowns. Figs. 8 & 9:
The accuracy of fit and the warm colour effect in this pure state were convincing.

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10
Fig. 10: Our polishing set for lithium disilicate crowns.

these can be mixed with GC Initial Spectrum Stains,
fine powder stains for infinite individualisation options.
Depending on each case, you can use the elements of
the system that you need.

As test users, we put GC Initial LiSi Block through its
paces from a dental technician’s perspective. We wanted
to know how well the ceramic works without any and with
individualisation. Processing and accuracy of fit were
also put to the test.
GC Initial LiSi Block in its pure version
For the first case, GC Initial LiSi Block was tested in its
pure version: mill, polish, place. As usual, model preparation, construction and nesting took place (see the
second case for a more detailed description). After
separating the restoration from the sprue, we only slightly
reworked the crown and polished it according to our protocol (Figs. 2–4). The accuracy of fit and the smooth
edges were just as convincing as the beautiful colour
effect. The surfaces after milling were homogeneous
and had a semi-gloss sheen. The excellent polishability
was also impressive; in just a few steps, a high gloss was
achieved. The result was appealing (Fig. 5), and the procedure was an adequate alternative to other procedures
but with a significantly reduced amount of work. For
patient work, however, we always prefer some icing on
the cake—the painting or micro-layering technique—to
achieve the most from the crown. In that case, we would
have characterised the crown a little darker.

13
Fig. 11: The crowns on the model before individualisation by means of the
painting technique. Fig. 12: Ready-to-use GC Initial IQ Lustre Pastes ONE
for a 3D colour effect. Fig. 13: The crowns after the characterisation firing
on tooth-coloured dies.

Insight into the dental laboratory

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GC Initial LiSi Block with an extra touch
In this case, three premolars were produced. The preparation of the virtual model as well as the CAD took place
as usual in the software. In just a few simple steps, the
fully anatomical crowns were created and ready for
import into the CAM software (Figs. 6 & 7). High- and
low-translucency blocks (in Shade A2) were tested. In
addition, we had set different quality levels via the milling
strategy (M1 CAD/CAM unit, Zirkonzahn; heavy wet, zirconia) to check the accuracy of fit. When calculating the
milling paths, the quality levels can be adjusted depending
on the milling time. The software displays the required
milling tools and informs about the required milling time.

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The milling resulted in smooth and precisely fitting edges.
The surfaces were also wonderfully silky. The first inspection of the model showed the extraordinarily good fit.
There was no obvious difference between the milling
quality levels. Only minor reworking—proximal fine adjustment, occlusal correction and homogenisation of the
surfaces—was necessary after separation from the sprue
(Figs. 8 & 9). Commercial abrasives can be used for this.
We prefer the following combination: silicone polishers,
polishing stones, buffs, bristles, ceramic fibre points and
a good polishing paste (Fig. 10). An appealing result with
natural opalescence and an inconspicuous beautiful
colour effect was already apparent (Fig. 11). Because of
the homogeneous, fine surface, the texture looked natural.
But we wanted that extra touch that distinguishes a
crown created by a dental technician. With GC Initial IQ
Lustre Pastes ONE, the crowns were individualised with
a touch of 3D colours and glaze pastes (Fig. 12). GC Initial IQ
Lustre Pastes ONE are a mixture of refined glass-ceramic
particles and can therefore be easily applied and purposefully positioned. Depending on taste or need, subtle
or intensive effects can be achieved. After the firing, we
were inspired by the crowns’ natural fluorescence and
their effect on the tooth-coloured stumps (Fig. 13). This
simple and economical approach produced a result that
could match that of a conventionally manufactured
crown. Owing to the inherent gloss of the GC Initial IQ
Lustre Pastes ONE glaze pastes, a shiny surface was
obtained (Figs. 14–16). This particular case did not require
detailed surface texture. However, when more texture is
necessary, like for a central incisor of a young patient,
SQIN ceramics can be added on top. The GC Initial
Spectrum Stains complete the range of possibilities.

Findings
Since no crystallisation firing had to be executed, the production time was significantly shorter. The fast milling
process resulted in smooth and precisely fitting edges.
Even after the characterisation or glaze firing, the accuracy of fit of the margins and the surface texture were
retained. We were also convinced by the natural opalescence and the vividly warm colour effect without loss of
value. An excellent gloss level could be achieved in just
a few minutes by polishing. In addition, simple, effective
individualisation was possible with the paintable colour and
form ceramic concept GC Initial IQ ONE SQIN. If necessary, impressive characterisation can be achieved with
a very thin layer of no more than 0.1–0.6 mm. GC Initial
LiSi Block will complement the portfolio of materials in
our laboratory. Especially when work needs to move
quickly or if a high level of cost-efficiency is required,
ceramics are not only an adequate alternative but also
the material of choice in certain cases for single-tooth
restorations. There is always our desire as dental tech

16
Figs. 14–16: Harmonious naturalness and a radiantly warm liveliness
from the inside out, achieved in a very short production time. (All images
courtesy of © Christian von Bukowski, MDT)

nicians to achieve more for every restoration, and this
is possible using GC Initial LiSi Block, offering natural
beauty, simplicity and versatility.
Reference
1 Rosentritt M, Kieschnick A, Hahnel S, Stawarczyk B. Materials Science
Compendium Dental Ceramics, 2019.

about
Christian von Bukowski became
a dental technician in 1990 at the
S taatliche Berufsschule München-Land,
a vocational school in Munich in
Germany, after three years of intensive
training in a commercial dental laboratory.
Thereafter, he attended the master school
for dental technicians in Halle (Saale)
in Germany from 1994 to 1996,
where he obtained his master’s degree. Since 2006, he has been
running his own laboratory in Unterschleißheim near Munich.

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Transforming dentistry with
groundbreaking technologies
Lifelike restorations with a micro-layer of porcelain
By Kuraray Noritake Dental Inc.

Some companies mainly make use of basic technologies developed by others to improve their products and introduce new ones, while other companies
conduct fundamental research and basic technology
development in-house. Is this difference relevant for
someone who uses the resulting products in the dental
practice or laboratory on a daily basis? It is. Companies
that develop everything from scratch usually have a
deeper understanding of the products and their production procedures, making it easier for them to modify
specific features, solve existing problems and respond
to market needs. This article describes the impact of
two basic technologies developed by Kuraray Noritake
Dental Inc. for the production of zirconia-based indirect
restorations.

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All-ceramic evolution
A milled monolithic or only minimally reduced core made of
high-strength ceramics plus a micro-layer of porcelain—that
is today’s formula for success in the production of highly aesthetic indirect restorations. The approach is far less complex
and time-consuming than traditional production and layering
procedures are, and its outcomes can be quite impressive.
Concerning aesthetics and function however, it is essential
that the right types of material are selected and combined.

The core: Multilayered zirconia technology
When the first opaque zirconia framework materials conquered the dental market, leading manufacturers cautioned

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that not all zirconia is alike. Significant quality differences
exist that depend on the raw materials selected as well
as the processing techniques and equipment used for
blank production. This is particularly relevant considering the increasing aesthetic potential of the core
materials and decreasing thickness of the veneering
porcelain.
When Kuraray Noritake Dental Inc. identified the need for
zirconia core materials that offer greater aesthetics with
a higher translucency and a tooth-like colour structure,
it decided to develop a completely new type of dental
zirconia. It began establishing a sophisticated raw material production, blank pressing and pre-sintering process in-house. This was the basis for the development
of the dental industry’s first polychromatic blank with a
seamless colour structure and precise shade matching
with the VITA classical shade guide. In order to identify
the best ingredients and procedures, the research and
development team experimented with different raw
materials, formulations and grain sizes, developed ways
to optimise the purity of the ingredients and focused
on perfectioning the homogeneity and density of the
blanks and—of course—the integrity of the different
layers. Currently, three products based on this original
multilayered zirconia technology are available for dental
laboratories: KATANA Zirconia UTML, KATANA Zirconia
STML and KATANA Zirconia HTML PLUS. They offer
different levels of translucency and flexural strength
(Fig. 1).
In June 2021, Kuraray Noritake Dental Inc. introduced a new,
next-level multilayered zirconia disc: KATANA Zirconia
YML. The company developed this blank in response

1
Fig. 1: Four-layer colour structure of a KATANA Zirconia Multi-Layered disc.

to the marked need for a universal zirconia with high
aesthetic potential. The blank offers colour, translucency
and flexural strength gradation, the highest translucency
being in the enamel and the highest flexural strength
being in the lowest body layer (Fig. 2).
All multilayered zirconia discs and the technology incorporated in them support the production of lifelike
restorations with reduced handwork. No matter whether
the user prefers to work with materials offering a
uniform strength and selects them depending on the
indication or with the universal solution, the effort in

2
Fig. 2: KATANA Zirconia YML: multilayered zirconia disc with colour, translucency and flexural strength gradation.

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The micro-layer: Synthetic feldspathic
porcelain technology

3
Fig. 3: Extremely regular margins of a KATANA Zirconia crown after milling
thanks to the favourable material structure.

finishing is reduced considerably owing to the optimised translucency and natural colour gradation of the
core materials. Furthermore, the quality of the restorations produced is high thanks to regular margins,
smooth surfaces and a precise fit as a result of the
homogeneous, high-density structure with low porosity
and a high level of purity (Fig. 3).

Differences are found not only in zirconia but also in
the performance of veneering porcelains. They typically
consist of feldspathic porcelain, and most of them are
based on natural feldspar. Depending on where this
feldspar is mined, it may have slightly different properties. That is why manufacturers of such natural feldspar-based veneering porcelains need to adjust their
formulations from time to time, and handling and aesthetic properties might be somewhat different with
every new system purchased. In the 1980s, these variations in the composition of natural feldspar led to
unpredictable material properties, causing difficulties in
reproducing the natural tooth colour and even porcelain
fractures and cracks appearing after firing of porcelainfused-to-metal restorations. Limited colour stability was
also an issue.
For Noritake Inc., one of the parent companies of Kuraray
Noritake Dental, these issues were reason enough to
start developing a different kind of porcelain. After
analysing the issues and weighing the possibilities,
a completely new synthetic feldspathic porcelain technology was developed (Fig. 4). It provides for stable
coefficients of thermal expansion, particle distribution

Fig. 4: Synthetic feldspathic porcelain technology with a structure resembling that of natural enamel.
4

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Fig. 5: Different micro-layering approaches with CERABIEN ZR FC Paste Stain. Fig. 6: Different micro-layering approaches with CERABIEN ZR Internal Stain
and CERABIEN ZR Luster porcelain, leading to highly aesthetic outcomes.

and colour, as it is no longer dependent on natural
sources of feldspar.
Originally, this technology was used in Noritake Super
Porcelain AAA (now Noritake Super Porcelain EX-3),
introduced in 1987, a veneering porcelain for metal frameworks. The technology also formed the basis for the development of CERABIEN ZR porcelain and CERABIEN
ZR FC Paste Stain for porcelain layering on zirconia. This
line-up of internal stains and porcelains was specifically
developed for micro-layering on zirconia. All products
have one thing in common: as they are based on synthetic feldspathic porcelain, they offer consistent mechanical and handling properties and predictable shade
effects. The material structure and particle distribution
resemble those of natural teeth, supporting lifelike outcomes (Figs. 5 & 6). Using the CERABIEN ZR FC Paste
Stain liquid ceramic system on a monolithic restoration
or on one with minimal cutback (0.1 mm) offers reduced
effort.

Connecting components: Touch
polymerisation and monomer technology
When needing to cement the finished prosthetic restorations on to implant abutments or frameworks, it is essential to select a cementation system that is able to fulfil
high aesthetic and functional demands. The PANAVIA
family of resin cements from Kuraray Noritake Dental Inc.
employs many different technologies that provide for a high
bond strength to various substrates and a tight marginal
seal. The key technology incorporated in any Kuraray
Noritake Dental Inc. cement is the original MDP monomer
invented by KURARAY CO., LTD. in 1981. It is capable of
establishing a particularly strong and long-lasting bond to
enamel, dentine, metal and zirconia. The self-adhesive resin
cement PANAVIA SA Cement Universal also contains the
LCSi monomer, a long carbon chain silane coupling agent.

This monomer forms a strong chemical bond with resin
composite, porcelain and silica-type ceramics (like lithium disilicate), removing the need for a separate silane
component (a primer or adhesive) when bonding these
types of prosthetic restorations. PANAVIA V5, the strongest cement in the PANAVIA line, employs touch polymerisation technology. It seals the interface between the

“The key technology
incorporated in any
Kuraray Noritake Dental
cement is the original
MDP monomer invented by
KURARAY CO., LTD. in 1981.”
tooth and the restoration to prevent microleakage and
provides for a high polymerisation ratio even when
dark-polymerising and hence delivers a strong bond in
virtually every situation.

Conclusion
KATANA and CERABIEN are excellent partners for a
simplified approach to lifelike restorations. The high level
of quality and reliable performance offered by these solutions are due to proprietary technologies and streamlined
in-house production procedures that really make a difference. PANAVIA resin cement systems based on proprietary monomer and polymerisation technology are the
perfect choice for cementing prosthetic restorations on
to implant abutments or frameworks.

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| interview

Prof. Rainer Seemann believes that:

“Dentsply Sirona World provides a
window into the future
of dentistry, which is digital”
By Iveta Ramonaite, Dental Tribune International

I am the vice president of global clinical research and
currently act as chief clinical officer for Dentsply Sirona.
Furthermore, I am a professor in the department of
operative, preventive and paediatric dentistry at the
University of Bern in Switzerland. I previously worked
in several positions at the dental school and clinic of
Charité—Universitätsmedizin Berlin in Germany before
I joined Dentsply in 2006.
How exactly does your academic expertise benefit
your position as vice president at one of the world’s
largest dental companies?
As the largest manufacturer of professional dental
products and technologies, we do research and education in partnership with researchers and education
providers all around the globe. Dentsply Sirona is also
one of the world’s top providers of clinical education
programmes in the dental industry.

Prof. Rainer Seemann. (All images: © Dentsply Sirona)

Every year, Dentsply Sirona (DS) World offers a
comprehensive educational programme with breakout sessions, live demonstrations of surgery, hands-on
courses, networking opportunities and live entertainment.
This year will be no different, since the event is guaranteed to meet every dental practice’s needs. In the run-up
to DS World 2022, Dental Tribune International had the
opportunity to speak with Prof. Rainer Seemann, who is
an integral part of Dentsply Sirona, about working at one
of the world’s largest dental companies and about how
it is helping to shape the future of oral health.
Prof. Seemann, could you please introduce yourself to our readers by giving them some information
about your professional and personal background?

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My academic background allows me to confidently
assess the quality of research partners and understand
the needs of both dental students and professionals,
especially when it comes to training and clinical education. I have an influence on the choice of programmes
offered, and thus it is my responsibility to keep a finger
on the pulse in order to be able to guide our teams in
developing the most up-to-date courses in a variety of
formats.
Dentsply Sirona promotes the development of innovative training programmes with state-of-the-art
technology through extensive cooperation with
universities around the world. How would you define Dentsply Sirona’s main objectives with regard
to improving global oral health, and what role does
the dental industry play, in general, in shaping the
future of oral health?
Let me start with answering the last part of your question by asking what dentists can do to improve the
health of their patients. By providing science-based
dental products and solutions, Dentsply Sirona enables

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interview

Dentsply Sirona World attendees can try new product innovations such as Primeprint Solution, a medical-grade 3D-printing system for dental practices and laboratories.

dental professionals to create healthy smiles. That is our
wonderful mission!
As far as education is concerned, aside from our own
programmes, we collaborate with the leading universities and institutions that are shaping the dentists of
the future. To date, Dentsply Sirona has supported
1,000 universities, clinics and hospitals around the
globe in the planning and construction of new wings
and training facilities. These include the National University Centre for Oral Health in Singapore, the University Center for Dental Medicine in Basel in Switzerland
and the University of Otago in New Zealand. We believe
that, with reliable simulation units and treatment centres
as well as modern digital dentistry solutions, students
will be well prepared to provide the best care for their
future patients.
Everything we do, including empowering the dental
community with state-of-the-art training programmes
and ensuring young dental students are equipped to
thrive in this new digital era, is done with the aim of improving oral health globally and creating healthy smiles.
And when people can confidently smile, they can do
more, achieve more, be the best version of themselves.
It really is more than just teeth, and I am inspired to
work with our partners who are passionate about the
same vision.
Recently, students’ outstanding achievements in
restorative dentistry were honoured as part of
Dentsply Sirona’s Global Clinical Case Contest.
Could you please tell us a bit more about this
competition?

You have really chosen a personal favourite of mine!
The Dentsply Sirona Global Clinical Case Contest, or
GCCC, has been held since 2004/2005. The competition is aimed at dental students with less than two years
of clinical practice. Each participant documents his or
her successful treatment case in text and images and
is supported by a university tutor.

“Everything we do [...]
is done with the aim of
improving oral health globally
and creating healthy smiles.”
This year, over 520 students from around 73 dental schools took part in the competition, and the top
three contestants were presented with an award and an
array of opportunities for networking and education.
I was truly fascinated by the clinical case submission of
the first prize winner, Nanthiphorn Pongam from Mahidol
University in Thailand. At a young age, she is displaying
confident skill, careful knowledge and genuine passion.
Applications for GCCC 2022–2023 are open. I encourage all interested dental students to submit their
applications by going to the Dentsply Sirona GCCC
website (www.dentsplysirona.com/en-us/discover/
discover-by-topic/our-programs/gccc-global-clinicalcase-contest.html). I look forward to seeing some
incredible cases!

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Networking, education, entertainment, innovation—all happening at Dentsply Sirona World 2022.

Dentsply Sirona has been providing sophisticated
training for about 20 years, for example through its
academy in Bensheim in Germany. How has the
SARS-CoV-2 pandemic and the related increasing
demand for online training influenced clinical education programmes at Dentsply Sirona?
Looking back, the pandemic was a difficult period
for everybody. However, we took it upon ourselves
to adapt quickly in order to meet the changing needs
of dental professionals globally. Thanks to that, 2021
saw more than 280,000 dental professionals from
74 countries take part in one or more courses offered
by Dentsply Sirona, even as COVID-19 restrictions
eased and dental practices grappled with a return to
business as usual.

Dentists, technicians, hygienists, dental assistants, students and distributor sales representatives took part
in almost 8,000 courses altogether, including live lectures, product training and self-instructional courses.
Since restrictions have lifted, appetite for in-person experiences is back on the rise, and dental professionals
joined 2,246 live, in-person training sessions on specific
Dentsply Sirona technologies in 2021—up from 1,367 in
the previous year, making this the most popular course
format above both self-study courses and live webinars.
Online on-demand courses also grew in popularity.
Therefore, we offered 275 on-demand courses in
2021, compared with 175 the year before, addressing
the need for more flexible programmes to fit around

Dentsply Sirona offers a wide variety of courses and programmes to the dental community, including in-person training.

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[45] =>

interview

When students train using reliable equipment and the latest digital solutions, they are better prepared to provide the best care for their future patients.

increased workloads now that dental appointments
are full again.
All our efforts remain focused on improving dentistry in
order to provide safer and better dental care. We will
continue to listen to the needs of dental professionals
around the world and meet their demands so that we
can collectively move the industry forward.
This year’s DS World event will run under the theme
“Ultimate experience in digital dentistry”. How is
Dentsply Sirona living up to this theme, both at the
event and beyond?
DS World provides a window into the future of dentistry,
which is digital. And the future is already here. Attendees will be among the very first to experience the latest
groundbreaking digital innovations live. One of these is
DS Core, a platform that connects products, services
and technology in the dental clinic. This is a cloud solution, which we developed in collaboration with Google
Cloud. DS Core increases efficiency and facilitates
working with colleagues and partners. It is the gateway
to the digital universe of Dentsply Sirona. Also available in our main exhibition hall is Primeprint Solution,
our medical-grade 3D-printing system for dental
practices and laboratories, which easily integrates into
existing digital workflows, efficiently expanding a range
of indications.
We do not stop here. The magnitude of DS World
makes it an event every dental professional does not
want to miss. It is the ultimate experience in digital
dentistry because it is a very complete and compelling
event. Aside from the technologies and innovations
one can experience here, it is the only event that brings
together leading clinical education, networking among

peers and world-class entertainment. This year’s
headliners are stand-up comedian, television host and
Saturday Night Live legend David Spade and multiaward-winning Rock & Roll Hall of Famers Journey.
I can feel the electricity in the air as people from around
the world gather in one place to learn, share, exchange
and connect, which, in turn, helps dental professionals
provide better care to patients. It truly is unbeatable!

“The magnitude of
DS World makes
it an event every dental
professional does not
want to miss.”
In March, Dentsply Sirona announced its collaboration with Google Cloud and Primeprint, a new
3D-printing solution. Are there any other new research projects in the pipeline for this year?
That’s the thing about being pioneers—the end is
never in sight. There will always be a new technology to
unlock, a new dental challenge to address, a new piece
of information to uncover. This is what makes it exciting
to be in Dentsply Sirona and in the dental industry in
general. I cannot give away anything specifically, but
with regard to my area of responsibility, you can expect
our future solutions to always have dentists’ needs in
mind, backed by clinical research and data, all for
helping patients achieve healthy smiles.

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| trends & applications

How 3D printing increases value
for your patients
By Straumann

to grow at a compound annual rate of 25.9% to reach
US$15.9 billion by 2030, according to Grand View
Research.1

Guiding a new era
Precision is of the utmost importance during dental implant surgery to ensure the ideally positioned prosthesis
for missing or damaged teeth. However, the vast differences in each patient’s oral health and jawbone condition
rule out any sort of one-size-fits-all surgical guide or aid
to assist with such procedures. Therefore, customised
bone-, mucosa- or tooth-supported guides are often
used to achieve satisfactory implantation.

Introduction
Customisation has been an integral part of the increasing use of additive manufacturing in aesthetic dentistry.
Whether it be for producing implants, surgical guides,
or temporary crowns and dentures, 3D printing has
proved itself to be a valuable method of creating unique
solutions for patients while cutting back on costs and
time. Perhaps that is why the global dental 3D-printing
market’s value of US$2.0 billion in 2021 is predicted

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2 2022

Conventionally, such guides are produced through the
milling of moulds. Despite their stability and accuracy,
milled guides result in wasted material, and this is rather
costly. Furthermore, milling machines typically cannot
produce more than one guide at a time, and a milling unit costs a clinic anywhere from US$20,000 to
US$70,000 on average. These drawbacks can be
addressed using 3D-printing technologies such as
stereolithography and digital light processing, and such
3D printers can be purchased at a fraction of the price
of a milling device.

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trends & applications

Reduced costs and time, and better
understanding of the procedure for patients
Not only are the expenses reduced for dental professionals with
in-house 3D printers, but the money saved from outsourcing to
laboratories with traditional machinery can be passed on to patients. This is due to the reduced labour and shipping involved
when using digital solutions. The waiting time for customised
parts is also significantly reduced, as they can be made in under 20 minutes, depending on the models. Also, being able to
observe the process of the surgical models being made, the
patient can better comprehend his or her surgical procedure.

Fast production with Straumann’s
3D-printing portfolio
Straumann’s 3D-printing portfolio consists of a range
of 3D printers, accommodating both those familiar with

additive manufacturing and those implementing it in their
dental practices for the first time. Alongside these printers
are the P cure and the P wash, which take care of the
post-processing of the 3D-printed models. Straumann
offers a selection of 3D-printing materials. The PRO Resins
Model X, for example, have been engineered to create
strong and precise models. Nevertheless, the company’s
3D printers have open material systems to reduce experimental restrictions.
The earlier systems in the Straumann 3D printer series
enable fast in-office production of dental products such
as 3D-printed surgical guides, temporary crowns and
dentures, and splints. The Straumann series of 3D printers
can also be used to fabricate personalised gingival
mask parts and models. Moreover, these 3D printers
offer an increased printing speed suitable for dental laboratories. In a recent case, a 3D-printed temporary crown

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[48] =>

| trends & applications

of the Straumann P pro Crown & Bridge composite resin
was fabricated to prevent extensive bone resorption,
severe soft-tissue regression and surgical trauma, enabling
a pleasing and aesthetic restoration for the patient.
The later models, the P30+ and the P50+, focus on highcapacity 3D printing through automation. The P30+ has
integrated semi-automated printing and increased output,
and the P50+ improves upon the patented force feedback
technology, increasing print speed. This is complemented
by an automatic separation module and automatic material
refill, which optimises material usage and printing time.

Printing in a pandemic
The immediacy of 3D printing has also been proved useful in the COVID-19 pandemic. The shortage of protective
equipment and medical supplies became a concern
during the height of the spread of SARS-CoV-2, as tools
were being used up faster than they could be replaced.
To overcome this supply chain hurdle, members of the
University of South Florida Health’s Department of
Radiology and New York-based Northwell Health developed 3D-printed nasal swabs for COVID-19 patient testing.
Students from the University at Buffalo in New York
also began 3D-printing face shields and comfort bands
for local dental practices. These applications show that
3D printing can also be used to encourage overall patient
safety in addition to aiding in surgical procedures.
In early 2020, the International Digital Dental Academy in
the UK began a 3D-printing initiative, which includes over
13,000 digital dentists and technicians, to produce ventilator splitters, masks, visors and parts to aid front-line
healthcare workers and patients. Elsewhere, the Italian
dental laboratory Magma Center began contributing to the
fight against COVID-19 by printing 3D parts for respiratory
masks using the Straumann P40 printer.

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2 2022

Later that same year, Israeli 3D printer and materials
manufacturer XJet announced a global partnership with
Straumann. This collaboration was initiated with the aim
of accelerating the development of additively manufactured ceramic end-use parts via its Carmel 1400 3D
printer. The reduced manual labour involved in working
with this system offered the advantage of limiting the
spread of SARS-CoV-2, thus creating a safer environment for patients. At the time, Stephan Oehler, head of
technology and testing at Straumann, said: “There’s
already a demand for the ceramic parts produced on the
Carmel 1400, and social distancing is viable because
operation of the system is very simple, so we’ve been
able to keep the system running even through the global
pandemic.”

“Precision is of the utmost
importance during
dental implant surgery [...]”
Aligning with patient needs
3D printing in 2021was found to have the largest presence
in orthodontic practices, compared with those specialised in implantology and prosthodontics, and this is predicted to grow, according to the Grand View Research
report.1 This was attributed to increasing numbers of
misalignment and diastema treatments in North America.
Applications include 3D-printed orthodontic models
used for the creation of aligners through thermoforming.
In further developments, polycarbonate-based resins
have been used for the additive manufacture of clear
aligners. Such materials however are continuing to be
evaluated clinically.

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trends & applications

Similar to surgical guides, using 3D-printed orthodontic models gives patients a more personalised experience. In addition to customisation, 3D printing can
enable a more accurate aligner by eliminating the need
to manually trim or polish a model. These processes
are digitised in the 3D scanning, modelling and planning
stages. A patient can also be assured that if his or
her 3D-printed aligner is misplaced another can be
swiftly made from an STL file on the same day at a low
cost.
In comparison with traditional metal fixed appliances,
clear aligners are more discrete in appearance and
can be conveniently removed. Moreover, there are fewer
dietary restrictions and no obstructions while flossing or
brushing. In addition to these benefits, patients can
have their aligners made remotely. This is due to the
simplistic and digital workflow in which an impression
or scan can be taken at home and then sent to dental
professionals. With the information, a treatment plan
can be developed. Additive manufacturing can then be
used to directly make the aligners or to aid the making
of thermoformed aligners, which are then sent to the
patient. Smartphone apps are also being used as an
instructional tool to assist patients in correcting their
smiles.
Straumann recognised the value of the clear aligner
market in its 2017 acquisition of Texan clear aligner provider ClearCorrect and simultaneous purchase of a 38%
stake in Spanish aligner solutions laboratory Geniova.
In 2019, Straumann entered into the second largest
market for clear aligners—China—through a distribution
agreement with Tianjin Zhengli Technology Company.
The following year, Straumann invested in German clear
aligner provider DrSmile. Most recently, a case study
demonstrated the benefits of orthodontic treatments
using the ClearCorrect aligner system.

Conclusion
The value for patients of 3D printing in the dental industry
are optimised customisation, reduced costs and enhanced safety measures in implantology, prosthodontics
and orthodontics compared with traditional methods
of fabrication. Furthermore, patients can be in closer
proximity and gain a better understanding of dental procedures, as the digital workflow can be performed under
one roof. Nevertheless, although traditional manufacturing may seem more cumbersome compared with the
exciting developments of additive manufacturing, it is
important to remember that these technologies are able
to work collectively for the ideal patient care and that it
is not a choice between one or the other.

Further reading
If you would like to learn more about how 3D printing
is adding value to dentistry, please feel free to read following articles:
– KeySplint Soft now Validated for Dental Applications With
Straumann® P Series Printers (https://www.straumann.com/
en/discover/youtooth/article/digital/2021/keysplintsoft-now-validated-dental-applications-straumann-pseries-printers.html);
– S2E3: Designing and Printing the Surgical Guide
(https://www.straumann.com/en/discover/youtooth/
article/esthetics/2020/straumann-play-season-2ep-3-digital-for-your-dental-practice-with-dr-hugo-madeiradesigning-printing-surgical-guide.html); and
– Rapid Shape Reacts Rapidly on COVID-19 (https://
www.straumann.com/en/discover/youtooth/article/
digital/2020/rapid-shape-reacts-rapidly-on-covid-19.html).
Editorial note: A list of references is available from the
publisher.

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| trends & applications

Traditional subtractive methods
required outrageous sums of money:
The basics of additive manufacturing
By Forrest Hall, USA/Germany

Traditionally, the more accurate methods of forming
metal into the desired shapes have used subtractive
manufacturing, which is the process of removing material
to create a part. For years, engineers have used subtractive machines such as lathes and mills to create the custom parts that they have designed. However, subtractive
manufacturing is limited by the reach of the tools and
by the machine’s axis of movement. This is where the advent of additive manufacturing makes all the difference.
Rather than removing material to expose a part, additive
manufacturing lays down material to build up the part.
This is an engineer’s dream because it removes many design barriers that had previously prevented the building
of parts that are more advanced. An easy way to concep-

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2 2022

tualise it is to think of it like building a house: it is far more
practical to build the house layer by layer with bricks than
it is to carve the house out of a giant block of stone.
Additive manufacturing has grown in popularity in recent
years, and many unique methods have been developed
to allow for parts to be made of a broad spectrum of materials. The most common type of additive manufacturing
that may be familiar to readers is fused deposition modelling (FDM). This process involves extruding a plastic
filament through a heated nozzle similar to a hot glue gun.
An FDM printer moves in three axes as it lays down the
plastic layer by layer until eventually the desired part has
been formed.

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trends & applications

There are a number of other additive manufacturing
methods, including resin-based printing. With resin
printing, a UV light-sensitive resin is exposed to UV light,
causing it to harden, to form parts with great precision.
The UV exposure source can be controlled through
a variety of methods, such as liquid crystal display
(LCD). This process uses a transparent LCD screen
similar to that used for a computer monitor. The LCD
is programmed to essentially display an image of the
layers required to build up the parts, and in doing so,
the LCD darkens specific pixels, creating a mask that
only exposes the resin according to where the layer
requires.
Once that resin has been polymerised, the printing bed
the layer is sitting on is shifted, allowing for the next
layer to be deposited and interact with the UV light.
LCD printers have a drawback, as the UV exposure to
the LCD can damage it over time, requiring the screen
to be replaced.
Other resin systems operate somewhat similarly, such
as stereolithography (SLA), which scans a UV laser over
the resin to build the layers, and digital light processing
(DLP), which uses an array of micro-mirrors which function like individual pixels in a screen by reflecting UV light
on to and away from the image transfer optics. With the
DLP process, a whole layer can be exposed at a time,
leading to a faster build time.
These processes have found their way into many fields,
including dentistry, for fabricating retainers, dentures
and aligners, for example. However, resin printing has
a downside: it is weak. Typically, building things like
expanders and bone plates requires a strong biocompatible material such as titanium. Invented in 1995, the
process of direct metal laser sintering (DMLS) is employed in many professional fields as a state-of-the-art
manufacturing technique for producing robust parts
with complex geometry.
While the DMLS process is similar to the SLA technique,
it utilises a multi-thousand-watt fibre laser that scans
over a level bed of fine titanium powder rather than a
UV laser scanning over resin. With DMLS, the particles
of titanium melt and bind together to form a single metal
structure. This process has proved valuable in orthodontics, as the additive aspect allows printer operators
to build models with topography optimisation, a computer design process that generates complex organic
models that are lightweight but strong. Before DMLS,
having parts manufactured in titanium with traditional
subtractive methods required outrageous sums of money.
However, thanks to the advancements in machine
technology, custom titanium parts are now available to
a greater audience.

Forrest Hall

“This is an engineer’s dream
because it removes many design
barriers that had previously
prevented the building of parts
that are more advanced.”
about
Forrest Hall is a young entrepreneur and 3D-printing
enthusiast from Texas in the US whose experience designing
and building custom laser tables and 3D parts has led to
collaboration with international space programmes for part
production and design consults with parachute manufacturers
around the world. He currently lives in Germany,
where he is advancing his education in mechatronics,
additive manufacturing and engineering.

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[52] =>

| manufacturer news
Dry milling machines

Go automated with the P53DC

Increasingly efficient and productive, dry milling machines provide
precision fit and a high degree of aesthetics using a wide range
of high-tech materials to meet the clinical needs of patients.
Choosing a milling machine
The type of milling machine you need will be determined by the
type of material you want to mill. For zirconia, PEEK, PMMA, wax
and composite materials, dry milling is the ideal first choice for
machining. However, for glass-ceramic and hybrid composites,
a wet milling solution is required.

UP3D gives you a choice of separate dry and wet milling machines.
Why separate? From wet milling glass-ceramics to dry milling zirconia, you have to thoroughly clean and dry the machine between
the two processes, which wastes a great deal of time. Not doing
so runs the risk of cross-contamination and wet zirconia dust
build-up, resulting in residue that is difficult to remove. Having
two separate machines means that both can run simultaneously.
You will get better results and benefits from manufacturing
equipment designed for wet or dry milling.
Why choose the P53DC?
The P53DC milling machine has an automatic 12-disc changer
and remotely controlled automatic milling, enabling continuous
unattended operation 24 hours a day. Choosing an automated
milling machine will offer you increased productivity. The P53DC
also enables 90° vertical milling.
With highly integrated products, including self-developed design
software, a high-precision scanner and smart milling solutions,
UP3D brings you the most accessible dental digital technologies.
After-sales service, on-site training and online services are
available at your convenience. You can find more information
on the UP3D website.

www.up3ds.com

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[53] =>

[54] =>

| manufacturer news
A next-generation intra-oral scanner

3Shape introduces TRIOS 5 Wireless and five reasons
why you’ve got to have it

When 3Shape engineers set out to create a next-generation intraoral scanner, we enlisted dental professionals to help us decide
what it should include. Now, five years later, the results are awesome. The brand-new TRIOS 5 Wireless delivers over 50 improvements in ease of use and design!

TRIOS 5 introduces our new ScanAssist engine with intelligent
alignment technology. ScanAssist optimises your scan while you
scan to minimise misalignment and distortion. In fact, it makes
impression taking so simple that, with it, you can create a scan
strategy or scanning routine you prefer.

You will notice immediately that it is smaller and lighter. 3Shape
engineers have managed to pack all that award-winning TRIOS
power into an even more compact body. But that’s not all. Here
are five reasons why you will find TRIOS 5 irresistible.

In addition, TRIOS 5 includes a built-in LED ring around the
scanner body and haptic feedback (think Apple watches) that
help guide you while you scan to make digital impression taking
even smoother and faster. It uses the same artificial intelligence
technology that 3Shape scanners are famous for and removes
soft tissue optionally from your scans.

1. Simply ergonomic—30% more compact body design
At 26.7 cm in length and just over 300 g (with battery) in weight,
TRIOS 5 Wireless is our smallest and lightest intra-oral scanner to
date. The redesigned body is optimally balanced to fit comfortably
in any hand. In comparison, some competitor scanners weigh up
to 468 g and are more than 33 cm in length. A smaller, lighter
scanner makes it easier to manoeuvre and can mean less physical
stress on your team.
2. Simply effortless—intelligent alignment technology
when scanning
If you have used an intra-oral scanner, then you have experienced
misalignment or distortion in your 3D models. To remedy this,

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2 2022

3. Simply powerful–optimised battery life
The TRIOS 5’s batteries have been redesigned to be more
powerful and longer lasting. Combined with our new smart
power management that automatically switches TRIOS 5
to sleep mode to save energy, you can scan all day with
just one battery, giving you up to 66 minutes of scan time per
battery.
The batteries now also feature integrated LEDs, so you can
quickly gauge a battery’s charge level, and they charge four
times faster than our previous batteries.

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manufacturer news

4. Simply easier—no more calibrating your intra-oral scanner
This is something only present scanner owners will appreciate.
Every intra-oral scanner needs to be calibrated regularly to make
sure that the colours are imaged correctly. Thanks to its design
and re-engineering, the new TRIOS 5, however, does not need
calibration. Imagine not having to calibrate your scanner every
couple of weeks or when a patient is waiting in the chair!
5. Simply hygienic—a new standard in patient protection
and infection control
TRIOS 5 has reimagined intra-oral scanner design. The new-look
TRIOS is hygienically sealed up to its battery inlet with no cracks
or crevices that can collect any contaminants. A sapphire glass
window now encloses the autoclavable tip to create a sturdy
microbial barrier between patient and scanner. And we’ve included
single-use body sleeves that cover the entire area touched by
you to reduce cross-contamination risks. These changes make
TRIOS 5 especially easy to clean and disinfect.
More reasons for you to switch to TRIOS 5:
Three big bonus benefits
True wireless freedom
By now, you have heard about the advantages of having a wireless
intra-oral scanner, like not tripping on the cable, not pulling the
scanner off the table and not having it draped over your patient.
Being wireless, TRIOS 5 too has these advantages, but it takes your
wireless scanning to a whole other level: TRIOS 5 introduces TRIOS
Share, the world’s only solution that enables you to scan and plan
on every PC in your practice using just one TRIOS wireless scanner.

TRIOS Share connects your TRIOS 5 via Wi-Fi. That means you
can walk with TRIOS in your hand from room to room. You can also
use whatever PC is in your respective operatory to scan and plan
with (using our software)—even on your practice management
system PCs!
Digital dentistry at your fingertips—powered by 3Shape Unite
TRIOS 5 Wireless, like all 3Shape TRIOS scanners, includes the
3Shape Unite platform free. Together, TRIOS and 3Shape Unite
seamlessly connect you to over 2,000 dental companies, treatment solutions, practice management systems and laboratories,
represented as apps on the dental world’s most open and collaborative platform. Dentists can also take advantage of 3Shape
engagement apps, included free with TRIOS 5 Wireless, to help
boost treatment acceptance.
TRIOS 5 service agreement for your peace of mind
TRIOS 5 Wireless owners can take advantage of two TRIOS
service agreement options: TRIOS Care, which delivers focused
and extensive training and unlimited support for practitioners,
including express replacement if your scanner is damaged; and TRIOS
Only, a scan-ready free service agreement with no monthly costs.
From the moment you switch your TRIOS 5 on, TRIOS Care
provides you with complete assurance to enable you to focus on
delivering great treatments and reaching your full digital potential!

www.3shape.com

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[56] =>

| manufacturer news
Digital impressions for greater convenience and efficiency

Ceramill Map DRS intra-oral scanner allows for complete
arch scans in just 1 minute
time, making conventional impression taking superfluous. With the
scanner, both dentulous partial and complete jaws—before and
after preparation—as well as occlusal relationships and implant
positions, with the aid of scan bodies, can be scanned. Scanning tips
of different heights are available for areas that are difficult to access.
Intelligent features in the corresponding software, such as the automatic deletion of superfluous data and the counting of autoclave
cycles, offer clinicians further convenience. In addition, the preparation line can be defined and checked by the dentist in the scanning
software and then be adjusted if necessary.

Every restorative or orthodontic treatment starts with an intra-oral
impression, and dentists are increasingly employing digital technologies to achieve this. In addition to offering patients greater comfort,
these technologies help streamline the daily routines in the practice.
For example, the dentist can scan a jaw in just 1 minute with the
comprehensive Ceramill Map DRS intra-oral scanner from Amann
Girrbach. The end-to-end digital workflow also simplifies collaboration between the practice and the laboratory.
With Ceramill Map DRS, the clinician can digitally record the patient’s dental status and transmit the data to the laboratory in real

In order to facilitate access to these digital technologies, Amann
Girrbach offers various kits, which can be extended in stages. The
basis consists of the Ceramill DRS Connection Kit, which includes
the intra-oral scanner, the corresponding software and connection
to the company’s AG.Live digital platform. The Ceramill DRS HighSpeed Zirconia Kit allows zirconia to be sintered in the laboratory or
dental practice in just 20 minutes. Extension with the Ceramill DRS
Production Kit allows simple restorations to be fabricated in the
practice and placed in a single session.
“By digitising the data, smaller units can be fabricated and inserted
on the same day, depending on the distance to the laboratory.
At the same time, users benefit from our comprehensive training
and service offers,” explained Elena Bleil, product manager for
Amann Girrbach’s global clinical CAD/CAM business unit.

www.amanngirrbach.com/en/ceramill-drs

Safe surgery with always sharp drills

MIS releases replacement kits for guided surgery drills
Orit Kario, digital solutions product manager at MIS, commented:
“The kits are part of the MIS Stay Sharp approach.” She continued:
“We encourage clinicians to replace their drills before reaching the
recommended number of cycles. Working with worn drills increases
the bone temperature and may lead to implant failure. Sharp
drills meet the best conditions of safe and adequate implant bed
preparation.”

MIS Implants Technologies has recently added two drill replacement kits to its MGUIDE surgical sets line. These convenient kits
are compatible with both the conical and the internal hexagon
implant connections. They include the most used drills in guided
surgery procedures: pilot drills and site preparation drills.

CAD/CAM
2 2022

The guided surgery drill replacement kits are a welcome addition
to the MIS C1 and SEVEN drill replacement kits and help ensure
that a sharp new drill is available whenever it is time to replace a
worn-out one, thus contributing to patient safety and the success
of the treatment.
www.mis-implants.com

[57] =>

[58] =>

| features

Building a sustainable dental practice
Dr Sanjay Haryana, Sweden

Sustainable dentistry’s two major outcomes, namely
good oral health and reduced environmental impact,
could be achieved by focusing on preventive care and
quality operative care. However, the large amount of
waste produced by the dental office daily is a problem
that needs immediate attention.

take advantage of the trickle-down effect—the spreading
of attitudes and behaviours through the core of the
organisation. The team members must understand
why the change is necessary, feel responsible for their
roles and be inspired to take part in the sustainability
journey.

Reducing emissions—a complex task

For example, switching to green energy leads to a great
impact, requires little effort and minimises interruption to
day-to-day practice. To make sustainable procurement
more manageable, it can be divided into buying less,
wasting less and switching to products and services with
a lower carbon footprint.

Dental caries and periodontitis are two of the most
common diseases globally. Thus, the primary aim of sustainable dentistry is to improve the quality of life through
preventive care and quality operative care. In order to be
able to offer this to the underprivileged part of the global
population, increased emissions are inevitable.
However, from an environmental perspective, we want
the population to have immediate access to dental care,
but we do not want patients to visit the dental practice
too often. After the manufacturing of dental supplies
and the dental waste generated in daily practice, patient
and staff travel are the largest emitters of greenhouse
gases within dentistry. Since dental appointments accumulate over a patient’s lifetime, total emissions end up
being extremely high compared with those resulting from
other healthcare treatments.
In order to decrease emissions, FDI World Dental Federation promotes source reduction through good oral
health or prevention. This is because preventive dentistry
results in fewer appointments, fewer recall visits, a reduction in materials and, consequently, less clinical waste.
Dental diseases that are preventable or are in the early
stages of progression should be targeted using individualised maintenance plans where home care should be
the centre of attention.

Sustainable procurement
Why should dental professionals strive towards sustainable dentistry? Firstly, it is the right thing to do ethically;
secondly, it is a great marketing tool; and finally, it creates
an attractive workplace for new colleagues. Before taking
steps towards creating a green dental practice and
practising green dentistry, the practitioner should understand that sustainability minimises pitfalls and simplifies
the process.
To build a sustainable dental practice, it is essential to
establish the coming change with management and

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2 2022

“The primary aim of
sustainable dentistry is to
improve the quality of life
through preventive care and
quality operative care.”
Healthcare waste—a major problem
Medical and dental care generate substantial waste. The
healthcare sector is responsible for 5% of all the greenhouse gas emissions in the EU. Dental waste management
has been primarily focused on amalgam disposal, but this
is no longer the main issue. Even though it is well known that
dental practices generate great amounts of waste, there is
limited data available on the effect of this on the environment. Similarly to sustainable dentistry, dental waste management lacks a global consensus on how to tackle certain
environmental issues that are associated with dentistry.
In the day-to-day running of a dental practice, waste is
generated from all parts of the business and can be divided into three categories: household waste, hazardous
waste and clinical waste. Household waste is similar to
that which is generated in a residential environment and
should, if possible, be recycled. Hazardous waste is
considered harmful to people and/or damaging to the
environment and must be disposed of through the appropriate facility. It includes clinical waste, radiographic
solutions, amalgam and gypsum, which generates a toxic
gas during degradation in landfills.

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© IR Stone/Shutterstock.com

Clinical waste is defined as “any waste which consists
wholly or partly of human or animal tissue, blood or other
body fluids, excretions, drugs or other pharmaceutical
products, swabs or dressings, syringes, needles or other
sharp instruments”. It is also classified as hazardous and
should be incinerated.

The four Rs in dentistry
Waste management aims to protect humans and the
environment. If correctly done, it can also reduce costs
since most of the waste produced is clinical waste and
is more expensive to dispose of than household waste.
A popular way to manage waste has been to employ the
four Rs—reduce, reuse, recycle and rethink.
1. Reduce in the surgery
Many practices work with preset trays containing certain
instruments and disposable material, such as plastic
tray liners, gauze, cotton rolls and polishing paste. As
soon as the tray has been contaminated, all materials,
both used and unused, are classified as clinical waste.
Practices should review their set-up routines to minimise
the waste of unused material.
2. Reuse in the surgery
Most of the waste in dentistry consists of single-use
equipment designed to minimise cross-contamination.
There is a need for the development of novel solutions
allowing sterilisation and reuse. However, practices must
consider whether the equipment is safe for patients and
personnel and whether its production and use have
a positive impact on the environment.
3. Recycle in the surgery
This is the most challenging area since clinical waste
cannot be recycled. The most common materials found
in clinical waste are tissues, gloves and sterilisation
pouches. We should be able to establish routines that
allow us to open the pouches with clean gloves, separate

features

|

the plastic from the paper and recycle appropriately.
Small actions like this can have a positive impact on the
environment and save costs for dental practices.
4. Rethink in the surgery
Rethinking is the most important of the four Rs. Even
though reducing, reusing and recycling are the most
discussed, they do not adequately address the clinical
reality of dentistry or medicine. In order to meet the
Sustainable Development Goals of the United Nations as
set out in Agenda 2030, our suppliers must understand
the waste management system and align their dental
products and materials with the most appropriate
end-of-life procedure—incineration, landfill or recycling
(chemical or mechanical).

Moving forward
All clinical waste is destined for incineration and should,
therefore, be bio-based instead of fossil-based to reduce
net emissions. Additionally, a consensus is needed on
how to safely minimise single-use equipment. There are
many different types of plastics used in the healthcare
system, and a circular approach will never be accomplished
if they are recycled together. Our efforts in the clinical
setting will have little impact on sustainability unless there is
an alignment of equipment production, waste management
and end-of-life procedures. Only then can good oral health
and reduced environmental impact be achieved.

about
Dr Sanjay Haryana
is an education and
odontology specialist at
TePe Oral Hygiene Products.

CAD/CAM
2 2022

59

[60] =>

| meetings

In-person IDEM 2022 provided
forum for robust exchange of ideas
An interview with Mathias Kuepper
By Iveta Ramonaite, Dental Tribune International

Mathias Kuepper is the
managing director of Koelnmesse and has been helping to organise IDEM 2022,
which is Asia Pacific’s leading dental show, for nearly
a decade. Owing to the
SARS-CoV-2 pandemic, the
last edition of the biennial
event took place online.
However, this year, IDEM
returned to its beloved inperson format, although it
continued to offer some digital elements throughout the
event. In this interview with
Dental Tribune International,
Kuepper talks about event
highlights and the selection of a new location and
discusses the tremendous
value that IDEM has for the
dental industry.

With this year’s theme, we
hoped to provide a forum for
a robust exchange of ideas
as we navigate new challenges and explore the latest
market trends. Our aim was
to maintain competency, update and upgrade our knowledge and skills, and ensure
relevance in our attendees’
clinical practice. In this new
edition, participants to IDEM
2022 could expect digital elements throughout the event.
This allowed the participants
to extend their learning beyond the event days and
offer ample networking opportunities.

Mathias Kuepper.

Mr Kuepper, IDEM 2022 was held at a new venue,
Sands Expo and Convention Centre at Marina Bay
Sands in Singapore. Why did you choose this
specific location?
Based on our experience from the past in-person editions of IDEM, which were held across multiple floors,
we found that consolidating the exhibition and activities
on one floor is more convenient and accessible for our
exhibitors and attendees. The move of IDEM 2022 to
a larger exhibition hall at Sands Expo and Convention
Centre also serves to mark a significant milestone
for us as we welcome more sponsors, exhibitors and
speakers and expect more local and regional attendees
after the past four years of hiatus caused by the
SARS-CoV-2 pandemic.
The theme for this year’s event was “Building resilience in dentistry”. What was the message behind
the title?

CAD/CAM
2 2022

We are committed to maintaining high standards and
providing our participants with
the best experience for their
professional development in order to meet the changing requirements and challenges of today’s dynamic
environment.
Owing to the SARS-CoV-2 pandemic, the on-site
IDEM 2020 was cancelled and the event was
held online for the first time in its history. How did
you feel about coming out of the pandemic and
returning to the traditional in-person format this
year?
We were beyond excited to host IDEM 2022 in person
after four years. Although we hosted IDEM digitally
during the pandemic, we have heard from sponsors,
exhibitors and attendees that IDEM in a physical format
is an experience like no other. They find it more effective
and efficient to connect face-to-face with speakers,
partners, prospects and peers in order to learn about
the latest developments in dentistry. In the meantime,
it has given us more time to rethink formats and to

[61] =>

meetings

create more opportunities for businesses and attendees.
Thus, we have launched the IDEM360+ Community
platform to build a one-stop digital platform for the Asia
Pacific dental community to connect and exchange
ideas from any location.
Although held in a physical format, IDEM 2022
also featured some hybrid elements. Why do you
think this was necessary?
IDEM360+ is a digital community platform that adds
another layer of experience to IDEM. The platform allows participants to do business matching, find networking opportunities using the on-site lead generation
feature, book meeting slots, watch on-demand content
after the actual event day and more. IDEM360+ digital
platform and app are also available after the event,
and the trade exhibition will continue running virtually as
part of the IDEM360+ Community. Attendees can continue to access useful information for their practices,
and exhibitors can continue to engage and follow up
with visitors beyond the event days.
What was unique about IDEM 2022, and what
should the attendees most remember after this
year’s edition?
As the leading dental exhibition and conference in the
Asia Pacific region, IDEM gathered dental brands and
experts from all around the world at one venue and
offered networking opportunities and business growth
to all participants. We introduced a new programme,
the Singapore Speaker Series, to showcase our local
speakers. There was also a new initiative that aims at

“Our aim is to maintain
competency, update
and upgrade our knowledge
and skills, and ensure
relevance in our attendees’
clinical practice.”
nurturing young companies from the dental industry,
called the Innovation Arena, which permitted entrepreneurs to grow their network and explore different
business opportunities with IDEM. This year, there was
an increase in new exhibiting companies participating
for the first time in IDEM, and we could experience the
dynamic and fresh ideas that these companies added
to the already robust exhibition.
Would you like to add anything else?
We moved towards being a more sustainable event,
starting with this edition of IDEM. Taking our first
step towards this goal, the IDEM360+ digital platform
and app will be used as an all-in-one tool for networking, scheduling and navigating the event, replacing the need for bulk-printed materials like exhibition
and conference guides, venue maps and even name
cards.

CAD/CAM
2 2022

[62] =>

| meetings

Exhibitors stack up for
IDS’s centennial event in 2023
By Dental Tribune International
The International Dental Show (IDS) will take place
from 14 to 18 March next year, and more than 1,000 exhibitors have already registered for the event. The organisers say that the growing exhibitor list already includes
some of the key players in dentistry, such as Dentsply
Sirona, which opted not to attend the event in 2021 owing
to concerns relating to the SARS-CoV-2 pandemic.
IDS 2023 is set to be a jubilee event. It will be the 40th
iteration of the trade fair and will mark 100 years since
the first IDS took place in 1923. The organisers—the
Association of the German Dental Industry (VDDI) and
Koelnmesse—say that these milestones are a testament

62

CAD/CAM
2 2022

to the strength of the international dental industry, and
dentists from around the world are no doubt looking
forward to seeing their industry return to Cologne in
full force.
Owing to the pandemic, the 39th IDS was postponed by six
months and took place without a number of its stalwarts.
Dentsply Sirona and Ivoclar opted not to attend the event
in 2021 and have now both returned to the preliminary
exhibitor list (the list is available on IDS website).
Dentsply Sirona said in a press release that the company
will showcase its latest innovations in digital dentistry at

[63] =>

meetings

the event. Walter Petersohn, chief commercial officer at
the company, stated: “We are very excited to join IDS
2023 and reconnect with dental professionals from all
over the world for a week of knowledge sharing and networking.” He added that a full programme of events will
take place at the company’s booth.
Norbert Wild, managing director at Ivoclar Germany,
said in a VDDI and Koelnmesse press release that participating in the event will allow the company “to present
products and solutions and engage in a targeted exchange with dentists, dental technicians and dental
hygienists at one location”.
VDDI and Koelnmesse said that 400 companies from
11 countries have already registered for IDS 2023. Registrations from China, Japan, South Korea and Singapore
indicate that companies from the Asia Pacific region are
poised to make their mark on the event, and those from
Argentina, Brazil, Israel, Italy and the US suggest that
next year’s IDS will live up to the event’s reputation
as a truly international snapshot of the contemporary
dental industry.

“IDS 2023 is set to be
a jubilee event. It will be
the 40th iteration of the
trade fair and will mark
100 years since the first
IDS took place in 1923.”
IDS 2023 will be staged across 7 halls of the Koelnmesse
trade fair grounds in Cologne, and a total exhibition space of
180,000 m² will make it larger than pre-pandemic events.
In 2019, the 38th IDS covered 170,000 m² of exhibition space
and featured 2,260 vendors from more than 60 countries.
In 2021, the 39th IDS was downsized to 115,000 m² and
featured 830 exhibitors from 59 countries.
More information about IDS 2023 is available online at
www.ids-cologne.de.

CAD/CAM
2 2022

[64] =>

| meetings

International events

ADF 2022

ICOI World Congress

22–26 November 2022
Paris, France
https://adfcongres.com

13–15 April 2023
Sydney, Australia
www.icoi.org/events

GNYDM 2022

18th IDENTEX—
International Oral and
Dental Health Exhibition

25–30 November 2022
New York, USA
www.gnydm.com

4–7 May 2022
Antalya, Turkey
https://cnridentex.com

7–9 February 2023
Dubai, UAE
https://aeedc.com/
see-you-at-aeedc-dubai-2022

The British Dental Conference
& Dentistry Show

23–25 February 2023
Chicago, USA
www.cds.org/midwinter-meeting

12–13 May 2023
Birmingham, UK
https://birmingham.dentistryshow.co.uk

14–18 March 2023
Cologne, Germany
www.ids-cologne.de

64

2 2022

11–13 May 2023
Torino, Italy
www.eas-aligners.com

158th Chicago Dental Society
Midwinter Meeting

IDS 2023

CAD/CAM

4th EAS Congress

FDI World Dental Congress
24–27 September 2023
Sydney, Australia
www.fdiworlddental.org/
world-dental-congress-2023

© 06photo/Shutterstock.com

AEEDC Dubai 2023

[65] =>

|
© 32 pixels/Shutterstock.com

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Questions?
Magda Wojtkiewicz
(Managing Editor)
m.wojtkiewicz@dental-tribune.com

CAD/CAM
2 2022

65

[66] =>

| about the publisher

international magazine of dental laboratories

Imprint
Publisher and Chief Executive Officer
Torsten R. Oemus
t.oemus@dental-tribune.com
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Schmid
Copy Editors
Sabrina Raaff
Ann-Katrin Paulick
Contributors
Christian von Bukowski
Dr Francesco Gallo
Forrest Hall
Dr Sanjay Haryana
Dr Les Kalman
Mathias Kuepper
Marco Marzolla
Maurizio Melano
Dr Kübel Özkut
Dr Mario Perotti
Dr Michael D. Scherer
Prof. Rainer Seemann
Daniel Sussman
Dr Kamran Zamanian
Dr Francesco Zingari

International Administration

International Headquarters

Chief Financial Officer
Dan Wunderlich

Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
General requests: info@dental-tribune.com
Sales requests: mediasales@dental-tribune.com
www.dental-tribune.com

Chief Content Officer
Claudia Duschek
Clinical Editors
Nathalie Schüller
Magda Wojtkiewicz
Editors
Franziska Beier
Jeremy Booth
Brendan Day
Anisha Hall Hoppe
Iveta Ramonaite
Executive Producer
Gernot Meyer
Advertising Disposition
Marius Mezger
Art Director
Alexander Jahn

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04420 Markranstädt, Germany

Copyright Regulations
All rights reserved. © 2022 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH
is expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for
typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International GmbH.

CAD/CAM
2 2022

[67] =>

© MIS Implants Technologies Ltd. All rights reserved.

PERFECT
MATCH

DESIGNED FOR ACCURACY. MAKE IT SIMPLE
MIS MGUIDE is a keyless system, designed for single-handed procedures, eliminating the
need for unnecessary tools. The surgical template is designed with an open-frame for
maximum visibility, irrigation and accessibility from all angles without the need for removal.
Learn more about MIS at: www.mis-implants.com

[68] =>

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[cover] => CAD/CAM international No. 2, 2022

Table of contents

[toc_titles] =>

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